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?"

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
    • Select Billed in Error or Reprocess if appropriate. Both cannot be selected.
  • 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 Fri, 21 Feb 2020 07:47:29 +0000