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Self Service Reopenings

A self-service reopening is submitted by performing a claim status inquiry first. The Self-Service Reopening link is located under Related Inquiries.

This screen shows where to start a Self Service Reopening on the Noridian Medicare Portal.

Step 1: Selection

After selecting the link, if the message "Selected claim is not eligible for Self-Service Reopening. Please proceed with a redetermination" displays, this indicates the claim is too complex for a Self-Service Reopening.

This image shows the error message received when a claim is not eligible for Self Service Reopenings.

Items Too Complex for Self-Service Reopenings

  • Claims with initial determination dates over one year
  • Claims reviewed by CERT, Medical Review, Redeterminations, Recovery Auditor, Recoupment, ZPIC, other entity or paid by another contractor
  • Modifiers:  GA, GY, GZ, 22, 23, 66, and 74
  • Procedure codes: A0021-A0999, 81200-81383, 81400-81479, 83890-83914, 88367-88368, 88380-88381, 88384-88386

If all of these requirements are met, the reopening begins. First, select the Adjustment Type:

Note: If a combination option is chosen (ex. Procedure Code, Modifier and Billed Amount) it is not required to correct all elements. If only the Procedure Code needs correcting, the other items will remain as is.

Next, check the box next to the claim lines the reopening pertains to or use the select all checkbox to select all lines.

Note: If the boxes cannot be checked, this indicates the line item is too complex and the reopening cannot be done through the portal for that item. Additionally, MSP, Place of Service, Rendering NPI/PTAN and Referring NPI pertains to the entire claim, so line selection is disabled.

This is a screenshot of Step 1 of a Self Service Reopening. It indicates where the dropdown box of the adjustment types is located and where the boxes are to select the line(s) that they would like to adjust.

Step 2: Corrections

Billed Amount

The billed amount can be adjusted for selected lines. Each line must have a minimum billed amount of $0.01. The total claim billed amount cannot exceed $99,999.99.

This is a screenshot of Step 2 of a Billed Amount Self Service Reopening. It indicates where the Billed Amount can be updated.

Billed in Error

A provider may indicate the claim line(s) should not have been billed. No changes are needed to the claim; however, an overpayment will be created.

Date of Service

Providers may change the month and day of service. The year of service cannot be changed.

This is a screenshot of Step 2 of a Date of Service Self Service Reopening. It indicates where the month(s) and day(s) of the date of service can be updated.

Diagnosis

Providers may change any of the diagnosis codes or pointers listed on the claim.

Adding diagnosis

  • Locate an available pointer in the diagnosis table
  • Input the new diagnosis
  • If applicable, update the detail line with the appropriate diagnosis pointer

Removing diagnosis

  • Locate the diagnosis in the diagnosis table
  • Delete the diagnosis
  • If applicable, update any detail lines containing that diagnosis pointer with a valid pointer

Changing diagnosis

  • Locate the diagnosis being replaced
  • Input the new diagnosis over the replaced diagnosis
  • If applicable, update any details lines with the appropriate diagnosis pointer

Note:

  • Primary Diagnosis cannot be left blank
  • All lines must contain one diagnosis pointer only

This is a screenshot of Step 2 of a Diagnosis Self Service Reopening. It indicates the table where diagnoses can be entered or removed and the location where the primary diagnosis pointer can be updated.

Modifier

If Modifier was selected, providers may add, replace or remove modifiers. List all modifiers consecutively and without spaces or commas. The existing or new modifier cannot be too complex for Reopenings.

This is a screenshot of Step 2 of a Modifier Self Service Reopening. It indicates the location where the modifier(s) can be added, removed or changed.

MSP Type

Providers can update the two-digit MSP type. When selecting this adjustment type, all lines on the claim are automatically selected.  

Two Digit MSP Type Description
12 Working Aged
13 ESRD
14 Auto/No Fault
15 Worker's Compensation
16 Federal
19 Worker's Compensation Set-aside
41 Black Lung
43 Disability
44 Liability Insurance Medicare Set-aside
45 No-Fault Insurance Medicare Set-aside
47 Liability

This is a screenshot of Step 2 of an MSP Type Self Service Reopening. It indicates the location where the MSP type can be updated.

Place of Service

Providers can update the two-digit place of service. When selecting this adjustment type, all lines on the claim are automatically selected.

This is a screenshot of Step 2 of a Place of Service Self Service Reopening. It indicates the location where the place of service can be updated.

Procedure Code and Billed Amount

Providers can change the procedure code and billed amount. The existing or new procedure code cannot be too complex for reopenings. The billed amount must have a minimum billed amount of $0.01 on each line and the total claim billed amount cannot exceed $99,999.99.

This is a screenshot of Step 2 of a Procedure Code and Billed Amount Self Service Reopening. It indicates the locations where the procedure code and billed amount can be updated.

Procedure Code, Modifier and Billed Amount

Providers can change the procedure code, modifier and billed amount. The existing or new procedure code and modifier cannot be too complex for reopenings. The billed amount must have a minimum billed amount of $0.01 on each line and the total claim billed amount cannot exceed $99,999.99.

This is a screenshot of Step 2 of a Procedure Code, Modifier and Billed Amount Self Service Reopening. It indicates the locations where the procedure code, modifier(s) and billed amount can be updated.

Rendering NPI and PTAN

When selecting this adjustment type, all lines on the claim are automatically selected.

This is a screenshot of Step 2 of a Rendering Provider Self Service Reopening. It indicates the locations where the Rendering NPI and PTAN can be updated.

Referring NPI

When selecting this adjustment type, all lines on the claim are automatically selected.

Note: If the referring provider's name must be updated, enter the referring provider's NPI. The name will automatically correct.

This is a screenshot of Step 2 of a Referring Provider Self Service Reopening. It indicates the location where the Referring NPI can be updated.

Reprocess

Providers may choose to reopen the claim as it was originally billed. An example of this is when the beneficiary's eligibility has changed for the date of service on the claim; no changes are needed but the claim does need to reprocess.

Units and Billed Amount

Providers can update the units on selected lines. Units must be minimum of .1 and cannot exceed 9999.9. For Anesthesia services, total minutes must be divided by 15 to get the correct units. The billed amount must have a minimum billed amount of $0.01 on each line and the total claim billed amount cannot exceed $99,999.99.

This is a screenshot of Step 2 of a Units and Billed Amount Self Service Reopening. It indicates the locations where the units and billed amount can be updated.

Units, Modifier and Billed Amount

Providers can update the units on each selected lines. Units must be minimum of .1 and cannot exceed 9999.9. For Anesthesia services, total minutes must be divided by 15 to get the correct units. The existing or new modifier cannot be too complex for reopenings. The billed amount must have a minimum billed amount of $0.01 on each line and the total claim billed amount cannot exceed $99,999.99.

This is a screenshot of Step 2 of a Units, Modifier and Billed Amount Self Service Reopening. It indicates the locations where the units, modifier(s) and billed amount can be updated

Step 3: Submission

Step 3 provides the user with updated claim lines. Review the changes, select the checkbox to verify the changes and submit the request using the Submit Request button.

This is a screenshot of Step 3 of a Self Service Reopening. It indicates the box to check after ensuring that all changes are accurate as well as the Submit Request button.

Step 4: Confirmation

Step 4 provides the Confirmation Number of the reopening. This indicates the reopening was submitted and will be processed.

Note: Confirmation of the adjustment does not guarantee payment. Adjustment claims are subject to claims processing policies and procedures.

This screen shows the confirmation number for a Self Service Reopening on the Noridian Medicare Portal.

Follow-up

To follow-up on the processing of the reopening, view the adjusted claim under Claim Status. The adjusted claim will be viewable one business day after the reopening is submitted.

 

Last Updated Oct 24, 2018