Self Service Reopenings (Part B)

A self-service reopening or recoupment request is submitted by performing a claim status inquiry first. The Self-Service Reopening link is located under Related Inquiries once the claim has been retrieved.

Step 1: Selection

The first question asked will determine if a Self-Service Reopening or a Recoupment Request will be completed.

"Is this an overpayment refund?"

  • Do you have a Corporate Integrity Agreement with OIG?
  • Have you received notification that this claim is under review by an external auditor (SMRC, ZPIC, RAC)?
    • If Yes, continue onto the Part B Recoupment Request instructions
      • Note: This should only be selected if the claim in question follows one of the above-mentioned scenarios.
  • If No, continue with the following steps

Choose one of the following:

  • Reprocess Claim - Provides a "pop-up" box asking if you are sure you want to reprocess the claim. Choose Cancel or Submit.
  • Cancel
  • Modify Claim - Choose Adjustment Type(s):
    • Billed Amount
    • Billed in Error
    • Date of Service
    • Diagnosis
    • Modifier
    • MSP Type
    • Place of Service
    • Procedure Code
    • Referring Provider
    • Rendering Provider
    • Reprocessing
    • Units
  • If Billed in Error is selected, a Billed in Error Reason Code needs to be selected
    • Billing Error
    • Duplicate
    • Code Change
    • Corrected Date of Service
    • Not our Patient
    • Services not Rendered
    • Modifier Add/Remove
    • Insufficient Documentation
    • Patient in an HMO
    • Veterans Administration Paid
    • Medical Necessity
    • Patient in Skilled Nursing Facility
    • PacMed
  • Choose claim line(s) the adjustment will apply to
    • If Billed in Error is the adjustment, place a check mark next to the line item AND Billed in Error.

This image shows where that the Select and the Billed in Error check boxes need to be selected with performing a Billed in Error reopening.

  • Choose Next

Step 2: Corrections

All fields that are able to be adjusted are opened to make corrections. Once the correction has been made, choose Next.

Step 3: Submission

Step 3 provides the user with updated claim lines based on the changes selected. Review the changes, select the checkbox to verify the changes are accurate and choose Confirm Changes.

Note: Error messages will be displayed if the claim cannot be modified with further instructions.

Step 4: Confirmation

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

 

Last Updated Mon, 01 Mar 2021 15:53:04 +0000