Reopening

The Reopening process allows providers to correct clerical errors or omissions without having to request a formal appeal. Most reopenings can be initiated through Self Service Reopenings via the Noridian Medicare Portal (NMP). All other requests can be initiated by telephone or in writing.

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 Monetary Threshold to be Met 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 None 60 days from receipt date Contractor

Submit a Self Service Reopening for the Below

  • Billed Amount
  • Deny services billed in error
  • Diagnosis
  • Modifiers-see exceptions below
  • Month/Day of service changes
  • MSP Type
  • Place of service
  • Procedure code and Billed Amount
  • Procedure code, Modifier and Billed Amount
  • Rendering NPI and PTAN
  • Referring NPI
  • Reprocess Claim (without changes)
  • Units and Billed Amount
  • Units, Modifier and Billed Amount

Request a Telephone or Written Reopening for the Below

  • Clinical Laboratory Improvement Act (CLIA) Numbers
  • Clinical Trial (CT) Numbers
  • Investigational Device (IDE) Numbers
  • Mammography Certification Numbers
  • Post-operative dates
  • Changing Initial Treatment dates

Items Too Complex for Reopenings

  • The below 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
    • Participating to Non-Participating
    • Year of service
  • Request a Redetermination for the below.
    • Claims reviewed by the Recovery Auditor, Recoupment, CERT, ZPIC or other entity
    • Modifiers: CR, GA, GY, GX, 22, 23, 66 and 74
    • Procedure codes: A0021-A0999, 81200-81383, 81400-81479, 83890-83914, 88367-88368, 88380-88381, 88384-88386
    • Changing or adding descriptions for unlisted procedure codes and injections

Reopenings Spreadsheet Requirements

Effective December 4, 2017, the Reopenings department will no longer accept requests containing a spreadsheet(s). Providers are encouraged to submit all reopening requests via the Self-Service Reopening option within the Noridian Medicare Portal (NMP). If you are a provider who is unable to register and use NMP, Reopenings will continue to accept three (3) claims per call. Providers can also use the written reopening form.

Visit our Noridian Medicare Portal webpage to read more about NMP registration and/or the Self Service Reopenings option.

Spreadsheet Guidelines

  • Must be submitted on the provided Reopenings Template [Excel]
  • Must be typed (hand written will not be accepted)
  • Must have at least 100 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), wait at least three business days before initiating a Reopening
  • 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, 2017