Medical Review

Medical Review / 56900 Reopenings

Users may request an MR Reopening in situations where the time to respond to a either a pre- or post-pay ADR has passed.  If the documentation is received after 45 days but within 120 days, the MR ADR may be reopened and processed.

  • Part A/HHH User: Select the Claim # to view the MR Detail Claim Status page then click the “Request 56900 Reopening” button located at the bottom of the page.
    • You may also access the form by clicking the “Request 56900 Reopening” button on the dashboard.

      MR Detail Claim Status page
  • Part B User: Click the “Redetermination” button from the MR Detail Claim Status page

    Request Redetermination

The form will load pre-populated with details from the claim.  Complete the remaining required fields (identified with an asterisk (*)) including the section noting the reason for the request.

Reopening Request page

Complete the rest of the form.  Attach the documentation requested in the original ADR (in a PDF format) and enter your name and direct phone number.  Click “Submit” to send the form.

Once processed, you will know that an MR ADR was reopened by its status noted on the MR Dashboard.  A banner will also appear in the header of the MR Detail Claim Status page.


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