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January 28, 2015 – Revised: 12.14.22

Helpful Hints and Reminders

Part B Reopenings may be accepted to correct minor errors and omissions on previously processed claims. When submitting requests to reopen claims, please consider the following helpful hints and reminders:

  • Written Reopenings can only be submitted via the myCGS Web Portal (the preferred method) and through mailed, hardcopy paper forms. Fax submissions are not accepted.
  • Do not submit multiple requests for the same initial claim. One request per claim, one claim per myCGS Web Portal or Paper form is required. Note: Sending multiple requests for the same initial claim can result in incorrect adjustments, overpayments, or letters to be returned.
  • Reopenings requests are subject to timely filing denials after 12 months to the specific date from the “original/initial claim” remittance date. Please submit prior to this time.
  • Claims rejected as “unprocessable” (remark code MA130) must be filed as a new claim and are not eligible for any type of reopening. These are not an “original/initial claim” for timely filing requirements.
  • Lines cannot be added to a claim which is already processed for payment or denial. The additional lines that were not billed must be filed as a new claim.
  • Inquiries will not be accepted if sent as a Reopening. Inquiries must be handled by the Provider Contact Center.
    • Examples of "inquiries" include:
      • Asking for the status of claims or Reopening requests previously submitted
      • Questions regarding denied and/or rejected (Return-to-Provider (RTP)) claims
      • Questions on the amount paid on processed claims
      • Requests to reprocess previously submitted claims without identifying specific error or changes needed
  • Payment adjustment/reductions as a result of CMS programs must be addressed by CMS directly.
  • Corrections cannot be made until the initial claim or previous adjustment has completed and a remittance is received. Do not submit corrections until the initial claim is finalized.
  • For myCGS Web Portal requests, access the form from the Claims tab to allow all information for a specific claim to auto populate correctly.
  • Accuracy is required. Utilize the CGS version of the remittance advice to obtain claim numbers, beneficiary information, and claim line details such as number of lines, and the line for a specific procedure code.
  • When submitting hardcopy paper requests, we recommend you access the form online, type, and then download and print.
  • Claims which have an Overpayment recoupment previously taken are not clerical reopenings. Please follow the instructions in the letter from the Overpayment Recovery Department.
  • Medically Unlikely Edit (MUE) denials for exceeding the limit allowed for a procedure code are appeal requests and should be submitted to the Redeterminations department with all required information and documentation.
  • Clerical reopenings must only be submitted with the patient’s Medicare Beneficiary Identifier (MBI).
  • When submitting a reopening request, please utilize the myCGS web portal for optimal experience.

Reviewed: 12.08.23

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