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Reopenings for Minor Errors and Omissions

Overview

There is no need to request an appeal/redetermination if you have made a minor error or omission in filing the claim, which, in turn, caused the claim to be denied. In the case where a minor error or omission is involved, you can request Medicare to reopen the claim so the error or omission can be corrected, rather than having to go through the appeal process. You can request a reopening for minor errors or omissions either by telephone or in writing. You have one year to request a reopening from the date on your Remittance Advice (RA).

Examples of minor errors or omissions include:

The following are examples of what cannot be handled as a Reopening:

Because some issues are more complicated than others and may require more research or consulting medical staff, the DME MAC reserves the right to decline the clerical error reopening and request that you submit a written redetermination.

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Telephone Reopenings

The DME MAC telephone reopening number is 1-866-813-7878. This line is in service Monday through Friday, from 8 AM to 10:30 AM and from 12 PM to 3:30 PM, Central Standard Time.

Use the telephone reopening process to resolve minor errors or omissions involving:

Wait to call the telephone reopening line until you receive your Medicare remittance notice. No action can be taken until a final claim determination is issued.

Callers should consult the Jurisdiction C DME MAC Supplier Manual and applicable medical policy guidelines before calling. Failure to have appropriate information available when you call the telephone reopening line may result in an unfavorable decision.

Questions about the status of a claim, or general Medicare payment and coding questions, should not be directed through the telephone reopening line. Suppliers can obtain a claim status report by using myCGS, our free online portal. The information is also available through the Interactive Voice Response (IVR) system or by using Claim Status Inquiry (CSI).

Suppliers must have the following information on-hand before placing the call for a telephone reopening:

All medical information provided to the DME MAC must be documented in the patient's file and available to the DME MAC should an audit be required.

If a previous reopening decision has been issued, a redetermination must be made in writing.

To effectively service all callers, each call is limited to five claim issues.

The following issues are examples of what cannot be handled on the telephone reopening line:

Disclaimer: If any of the above changes, upon research, are determined to be too complex, the phone representative will inform the caller that these need to be sent in writing with the appropriate documentation as a written reopening or as a redetermination.

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Written Reopenings

Written Reopening requests should be made using the Medicare Reopening Request form found on our Forms page. If you wish to send a written request instead of using the Medicare Reopening Request form, be sure to include the following information with your reopening request:

For further assistance, please consult Chapter 13 of the DME MAC Jurisdiction C Supplier ManualPDF.

Written Reopening requests can be mailed or faxed.

Mailing Address

CGS DME MAC Jurisdiction C
ATTN: Clerical Error Reopening Department
PO Box 20010
Nashville, TN 37202

Fax Number

For a reopening with an underpayment fax to: 615.782.4649. For a reopening with an overpayment fax to: 615.782.4477

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