Reopening Request Checklist - JD DME

• Do you have a Noridian DME Standard Paper Remittance (SPR) or Medicare Electronic Remittance Advice (ERA) for the claim(s) in question?
  • If not, submit request to Durable Medical Equipment Medicare Administrative Contractor (DME MAC) identified on ERA or SPR

• Was the claim(s) in question denied as unprocessable?
  • If so, correct and resubmit new claim(s)

Note: Unprocessable claims with Remittance Advice (RA) message MA130 cannot be reopened. ("Your claim contains incomplete and/or invalid information, and no appeal or Reopening rights are afforded because the claim is unprocessable. Submit a new claim with the complete/correct information.")

• Is the claim denial due to a minor clerical error or omission (e.g., units of service, service dates, HCPCS coding, diagnosis codes, etc.)?
  • If so, a Reopening request is appropriate. Select a method below.

• What is the ERA or SPR date for the initial determination? Has more than one year lapsed since that date?
  • If so, requestor must submit a written reopening request detailing "good cause" reason for filing late
    • Good cause may apply for a late filing, see CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Publication, Chapter 29 as it addresses the issue of good cause for extension of the time limit for filing. If good cause is not found, request will be dismissed

• Has requestor reviewed all information listed above?
  • If so, request a Reopening. Select a method:
    • NMP - Log In Now
    • Telephone - View call details
    • Mail or Fax - View Written Reopening details