Reopening - JE Part A
Reopening
A Reopening is an action to correct a clerical error that resulted in an overpayment or an underpayment, even though the decision was correct based on the evidence.
| Time Limit for Filing Request | Monetary Threshold to be Met | Time Limit to Complete Request | Where to File |
|---|---|---|---|
| One year from initial determination date or after one year from receipt date due to overpayment via clerical error omissions | None | 60 days from receipt date | Contractor |
CMS defines clerical errors (including minor errors or omissions) as human or mechanical errors on the part of the party or the contractor, such as:
- Mathematical or computational mistakes
- Transposed procedure or diagnostic codes
- Inaccurate data entry
- Misapplication of a fee schedule
- Computer errors
- Denial of claims as duplicates which the party believes were incorrectly identified as a duplicate
- Incorrect data items, such as provider number, use of a modifier or date of service
Clerical errors or minor errors are limited to errors in form and content and that omissions do not include failure to bill for certain items or services.
The law provides that Reopenings may be performed to correct clerical errors (minor errors or omissions). It is at a contractor's discretion to decide what meets this definition and, therefore, determines what can and cannot be corrected through a Reopening.
Complete a Reopening/Submit a Request
There are two ways that a Reopening request may be requested/completed.
- Complete via Direct Data Entry (DDE)
- Complete Redetermination/Reopening Request Form and submit to Noridian
