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myCGS Part B Automated Reopenings: Reprocess Claim

Part B providers may submit Reopening requests to reprocess a claim that denied when there are no changes or updates to make to the actual claim. Examples include:

  • Global surgery denials that should be reversed due to an update to a different claim.
  • A patient's file was updated to show Medicare should pay as primary on a claim we originally processed as secondary.
  • An erroneous duplicate denial. NOTE: Make sure the duplicate denial is incorrect; otherwise the adjustment may result in payment errors and/or recoupments.

NOTE: Reopening requests must be submitted within 12 months of the original claim remittance date.

Automated Reopenings Request Form Instructions: Reprocess Claim

  1. Once you are logged into myCGS, select the FORMS tab.

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  2. From the Secure Forms page, select REOPENINGS from the Select a Topic drop-down box.

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  3. The Select a Type drop-down will default to REOPENINGS. Click on the "Reopenings: ER-J15-B-1010" link located at the bottom of the page.

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    The Reopening Request form will display. Required fields are identified by a RED asterisk (*). For your convenience, some fields of the form are pre-populated with information specific to your myCGS User ID and PTAN/NPI combination.

  4. Verify/complete the PROVIDER INFORMATION section.
    • Add your phone number in the appropriate field.

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  5. Complete the BENEFICIARY INFORMATION section.
    • Enter the patient's name
    • Enter the patient's Medicare ID.

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  6. Complete the CLAIMS INFORMATION section.
    • Enter the Claim Internal Control Number (ICN). The ICN is located on your CGS RA.

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    • Click the drop-down box under Type and select REPROCESS CLAIM.

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    • Under the Action drop-down box, select the Reprocess option.
    • The Line and Position drop-downs and the New Value field are not applicable when requesting to cancel a claim, so they will be grayed.

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    • Click ADD to attach this request to the form. NOTE: No other corrections can be made to this request.
  7. Submit your form by entering your name and click the SUBMIT button.

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