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

Self Service Reopenings May be Submitted for Any or All Combination of the Below Adjustment Types

Effective January 1, 2024, all corrections available through Self-Service Reopenings will be required to be completed on the Noridian Medicare Portal (NMP).

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

For reopening received on, or after January 1, 2024:

  • Dismissed if available on self-service reopening
  • You will receive a dismissal letter informing suppliers, or providers to utilize the portal

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, a claim may be denied 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, UPIC or other entity
    • Modifiers: AQ, CR, GA, GY, GX, 22, 23, 66, and 74
    • Procedure codes: A0021-A0999, G9156, 21079, 21080, 21085, 21208, 21210, 21215, 21025, 21026, 81200-81383, 81400-81479, 83890-83914, 88367-88368, 88380-88381, 88384-88386, Q4100-Q4399
    • Changing or adding descriptions for unlisted procedure codes and injections

Reminders

  • Providers must wait at least three business days, after receiving the Electronic Remittance Advice (ERA), before initiating a Reopening request
  • Providers must 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
  • Provider's should complete all claims research before submitting a Reopening request
  • The claim Internal Control Number (ICN) must be provided when requesting a Telephone Reopening
Last Updated Jun 19 , 2024