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Informational

How to Avoid Timely Filing Issues

Reopening requests must be submitted within 12 months of the original claim remittance date. Please be advised, you should not use this form if the change you are requesting will result in an overpayment; i.e., changing a procedure code to one that has a lower allowed amount than the code that was previously allowed and paid on the original claim.

Rejected/Unprocessable Claims

Claims which are rejected as "unprocessable" (remark code MA130 etc.) are not eligible for Adjustments. Rejected "unprocessable" claims are not reviewed for Adjustments and are not considered an "initial or original claim" for the determination of Timely Filing. Claims rejected as "unprocessable" must be corrected and refiled as a new claim.

Clearinghouses

Special note for regarding claim submission clearinghouses: if your clearinghouse transmits duplicate claim files (submits a claim file more than once), these claims cannot be adjusted through the reopenings process. In these cases, the claims in the second file will deny as duplicates, and claims in the initial file will deny based on Medically Unlikely Edits (MUEs). Once both claims have finished processing, refile the claim (as a clean claim) from the clearinghouse.


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