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Reopening

The Reopening process allows providers to correct clerical errors or omissions without having to request a formal appeal. A reopening can be initiated via the telephone, in writing or online through the Noridian Medicare Portal.

A contractor (Noridian) reserves the right to refuse to adjust a claim as requested if it appears that such an adjustment would risk incorrect payment on any claims not identified for correction.

Time Limit for Filing Request Time Limit to Complete Request Where to File Filing Options
One year from initial determination date or after one year from receipt date due to overpayment via clerical error omissions 60 days from receipt date Contractor

Request a Reopening for the Following

  • Billed Amount
  • Rendering NPI and PTAN
  • Deny services billed in error
  • Diagnosis
  • Mammography Certification Numbers
  • Modifiers-see exceptions below
  • Month/Day of service changes
  • MSP Type
  • Place of service
  • Post-operative dates
  • Procedure code changes-see exceptions below
  • Clinical Laboratory Improvement Act (CLIA) Numbers
  • Units/number of services
  • Investigational Device (IDE) Numbers
  • Clinical Trial (CT) Numbers

Items Too Complex for Reopenings

  • The following requests cannot be completed as a reopening; however, Reopenings can deny the claim as billed in error.
    • Assignment changes
    • Billing provider information
    • Claim line additions and deletions
    • Claims with initial determination dates over one year old
    • Claims reviewed by Redeterminations, Recovery Auditor, Recoupment or paid by another contractor
    • Participating to Non-Participating
    • Year of service
  • Request a Redetermination for any claim reviewed by Recovery Auditor, Recoupment, CERT, ZPIC or paid by another contractor Written Redetermination Form [PDF]
  • Modifiers: GA, GY, GX, 22, 23, 66 and 74
  • Procedure codes: A0021-A0999,  81200-81383, 81400-81479, 83890-83914, 88367-88368, 88380-88381, 88384-88386
  • Unlisted procedure codes

Reopenings Spreadsheet Requirements

A provider may wish to submit a spreadsheet to Reopenings when there are more than 50 claims with the same correction. To complete this, call Telephone Reopenings to receive an authorization code and fax number. See the guidelines below:

  • Must be submitted on the provided Reopenings Template [Excel]
  • Must be typed (hand written will not be accepted)
  • Must have at least 50 claims with the same correction
  • Obtain an authorization code and fax number by calling Telephone Reopenings
    • Codes expire 10 days from date of call and is only valid for one use
  • List each ICN only once on the spreadsheet

A coversheet must be provided with information below

  • Attn: Reopenings
  • State
  • National Provider Identifier (NPI)
  • Provider Transaction Access Number (PTAN)
  • Tax ID
  • Contact name and number
  • Confirmation Number

Reminders

  • Once receiving your Electronic Remittance Advice (ERA), please wait at least three business days before initiating a Reopening as claim may not have finalized in claims database
  • Check claim status through Interactive Voice Response (IVR) or NMP
  • Claims with message MA130 or N704 on ERA or SPR must be resubmitted as a new claim. All claims research should be completed by your office prior to requesting a Reopening

Last Updated Nov 08, 2016