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Reopenings for Minor Errors and Omissions

A clerical error/omission reopening is an action taken to change an initial determination to correct minor errors or omissions outside of the Medicare appeal process.

Reopening Facts

  • Clerical error/omission reopenings are considered “preredeterminations”
  • All reopenings are granted at the discretion of the contractor
  • A contractor’s refusal to reopen is not appealable; however, a party may request to appeal the initial determination—but must do so within the 120-day timeframe

What is a Clerical Error?

RECOMMENDED - Online Using NGSConnex

You can submit your reopening requests using our free, secure internet portal, NGSConnex. 

If you are an existing NGSConnex user, you can initiate a redetermination by completing the following steps:

  1. Click the My Claims tab
  2. If there is more than one provider account, click the Select button for that account
  3. Select Claims under the Claim Type drop down and click the Go button
  4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY)
    • You can narrow your search by entering from service date, to service date, and/or a claim number if you wish
  5. Click the Load Claims button
  6. Locate the claim you wish to initiate a redetermination for and click on the Claim Number
  7. Click the Initiate Redetermination/Reopening button
  8. Complete the redetermination form; all fields with red asterisk are required
  9. Click the OK button
    • If the form continues to display on your screen, scroll to the top of the form to locate your error message, correct the error and click on the OK button again
    • If you see an error message, make sure that all required fields are completed
    • If after clicking on the OK button, the form disappears and the My Redeterminations/Reopenings tab displays, the request was received
  10. If supporting documentation needs to be included with the redetermination, click on the New button under the attachment section to add the documentation
    • Note: There are no file size limitations to the attachments that can be submitted in NGSConnex; the only file types not accepted are: .xml, .log, and .cfg.

Please Note: If there are multiple services on the same claim in question (same ICN), you only need to submit a single redetermination/reopening request. You should not submit multiple redetermination/reopening requests for the same claim.

Log in to NGSConnex

In Writing

Complete the Clerical Error/Omission Reopening Request Form and return to the appropriate address for your jurisdiction.

Be sure to include the following information with your reopening request:

  • Beneficiary’s name
  • Medicare number
  • Date of the initial determination notice
  • Date of service
  • Indicate the specific clerical error/omission change you would like considered
  • Requestor name and address
  • NPI
  • PTAN
  • Tax ID
  • Requester telephone number and relationship to the beneficiary

Important: Be sure to sign and date the reopening request.

RECOMMENDED - Online Using NGSConnex

You can submit your appeal request for a claim determination or reopening using our free secure internet portal, NGSConnex. You can also check the status of your redetermination/reopening requests. 

If you are an existing NGSConnex user, you can initiate a redetermination by completing the following steps:

  1. Click the My Claims tab
  2. If there is more than one provider account, click the Select button for that account
  3. Select Claims under the Claim Type drop down and click the Go button
  4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY)
    • You can narrow your search by entering from service date, to service date and/or a claim number if you wish
  5. Click the Load Claims button
  6. Locate the claim you wish to initiate a redetermination for and click on the Claim Number
  7. Click the Initiate Redetermination/Reopening button
  8. Complete the redetermination form; all fields with red asterisk are required
  9. Click the OK button
    • If the form continues to display on your screen, scroll to the top of the form to locate your error message, correct the error and click on the OK button again
    • If you see an error message, make sure that all required fields are completed
    • If after clicking on the OK button, the form disappears and the My Redeterminations/Reopenings tab displays, the request was received
  10. If supporting documentation needs to be included with the redetermination, click on the New button under the attachment section to add the documentation
    • Note: There are no file size limitations to the attachments that can be submitted in NGSConnex; the only file types not accepted are: .xml, .log and .cfg.

Please Note: If there are multiple services on the same claim in question (same ICN), you only need to submit a single redetermination/reopening request. You should not submit multiple redetermination/reopening requests for the same claim.

Log in to NGSConnex

Contacting our Telephone Reopening Unit

TRU representatives are available:

  • Monday‑Friday: 8:00 a.m.‑4:00 p.m. (ET/CT).
  • Closed for training on the 2nd and 4th Friday of the month from 12:00 p.m.‑4:00 p.m. ET/11:00 a.m.‑3:00 p.m. CT

Please be prepared to provide the following information when you call the TRU:

  • Beneficiary’s name
  • Medicare HICN/MBI
  • Your name
  • Your phone number
  • Provider’s full name (The provider’s name will be listed on the Medicare Remittance Advice)
  • PTAN
  • Item or service in question
  • Date(s) of service in question
  • Reason for request

What Issues are Handled by the TRU? 

  • Assignment of claims (carrier errors only)
  • CLIA certification denials
  • Duplicate denials
  • MA plan denials (clinical trial or hospice related only)
  • Fee schedule incorrect
  • HIC/MBI corrections (carrier error only)
  • MSP – Medicare now primary
  • Patient paid amount (carrier error only)

Note: MSP claims can only be processed within one year from the date of denial or payment.

Exception: If Medicaid or another government entity paid in error, please submit a written request.

(Reference: CMS Internet Only Manual 100-04, Medicare Claims Processing Manual, Chapter 34, Section 10.11).

In Writing

Complete the Part B Reopening Request Form and return to the appropriate address for your jurisdiction.

  • J6 providers (Illinois, Minnesota and Wisconsin) should mail written reopening requests to:

National Government Services, Inc.
P.O. Box 6475
Indianapolis, IN 46206-6475

  • JK providers (Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont) should mail written reopening requests to:

National Government Services, Inc.
P.O. Box 7111
Indianapolis, IN 46207-7111  

What is a Clerical Error?

RECOMMENDED - Online Using NGSConnex

You can submit your reopening requests using our free, secure internet portal, NGSConnex. 

If you are an existing NGSConnex user, you can initiate a redetermination by completing the following steps:

  1. Click the My Claims tab
  2. If there is more than one provider account, click the Select button for that account
  3. Select Claims under the Claim Type drop down and click the Go button
  4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY)
    • You can narrow your search by entering from service date, to service date, and/or a claim number if you wish
  5. Click the Load Claims button
  6. Locate the claim you wish to initiate a redetermination for and click on the Claim Number
  7. Click the Initiate Redetermination/Reopening button
  8. Complete the redetermination form; all fields with red asterisk are required
  9. Click the OK button
    • If the form continues to display on your screen, scroll to the top of the form to locate your error message, correct the error and click on the OK button again
    • If you see an error message, make sure that all required fields are completed
    • If after clicking on the OK button, the form disappears and the My Redeterminations/Reopenings tab displays, the request was received
  10. If supporting documentation needs to be included with the redetermination, click on the New button under the attachment section to add the documentation
    • Note: There are no file size limitations to the attachments that can be submitted in NGSConnex; the only file types not accepted are: .xml, .log, and .cfg.

Please Note: If there are multiple services on the same claim in question (same ICN), you only need to submit a single redetermination/reopening request. You should not submit multiple redetermination/reopening requests for the same claim.

Log in to NGSConnex

In Writing

Complete the Clerical Error/Omission Reopening Request Form and return to the appropriate address for your jurisdiction.

Be sure to include the following information with your reopening request:

  • Beneficiary’s name
  • Medicare number
  • Date of the initial determination notice
  • Date of service
  • Indicate the specific clerical error/omission change you would like considered
  • Requestor name and address
  • NPI
  • PTAN
  • Tax ID
  • Requester telephone number and relationship to the beneficiary

Important: Be sure to sign and date the reopening request.

RECOMMENDED - Online Using NGSConnex

You can submit your appeal request for a claim determination or reopening using our free secure internet portal, NGSConnex. You can also check the status of your redetermination/reopening requests. 

If you are an existing NGSConnex user, you can initiate a redetermination by completing the following steps:

  1. Click the My Claims tab
  2. If there is more than one provider account, click the Select button for that account
  3. Select Claims under the Claim Type drop down and click the Go button
  4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY)
    • You can narrow your search by entering from service date, to service date and/or a claim number if you wish
  5. Click the Load Claims button
  6. Locate the claim you wish to initiate a redetermination for and click on the Claim Number
  7. Click the Initiate Redetermination/Reopening button
  8. Complete the redetermination form; all fields with red asterisk are required
  9. Click the OK button
    • If the form continues to display on your screen, scroll to the top of the form to locate your error message, correct the error and click on the OK button again
    • If you see an error message, make sure that all required fields are completed
    • If after clicking on the OK button, the form disappears and the My Redeterminations/Reopenings tab displays, the request was received
  10. If supporting documentation needs to be included with the redetermination, click on the New button under the attachment section to add the documentation
    • Note: There are no file size limitations to the attachments that can be submitted in NGSConnex; the only file types not accepted are: .xml, .log and .cfg.

Please Note: If there are multiple services on the same claim in question (same ICN), you only need to submit a single redetermination/reopening request. You should not submit multiple redetermination/reopening requests for the same claim.

Log in to NGSConnex

Contacting our Telephone Reopening Unit

TRU representatives are available:

  • Monday‑Friday: 8:00 a.m.‑4:00 p.m. (ET/CT).
  • Closed for training on the 2nd and 4th Friday of the month from 12:00 p.m.‑4:00 p.m. ET/11:00 a.m.‑3:00 p.m. CT

Please be prepared to provide the following information when you call the TRU:

  • Beneficiary’s name
  • Medicare HICN/MBI
  • Your name
  • Your phone number
  • Provider’s full name (The provider’s name will be listed on the Medicare Remittance Advice)
  • PTAN
  • Item or service in question
  • Date(s) of service in question
  • Reason for request

What Issues are Handled by the TRU? 

  • Assignment of claims (carrier errors only)
  • CLIA certification denials
  • Duplicate denials
  • MA plan denials (clinical trial or hospice related only)
  • Fee schedule incorrect
  • HIC/MBI corrections (carrier error only)
  • MSP – Medicare now primary
  • Patient paid amount (carrier error only)

Note: MSP claims can only be processed within one year from the date of denial or payment.

Exception: If Medicaid or another government entity paid in error, please submit a written request.

(Reference: CMS Internet Only Manual 100-04, Medicare Claims Processing Manual, Chapter 34, Section 10.11).

In Writing

Complete the Part B Reopening Request Form and return to the appropriate address for your jurisdiction.

  • J6 providers (Illinois, Minnesota and Wisconsin) should mail written reopening requests to:

National Government Services, Inc.
P.O. Box 6475
Indianapolis, IN 46206-6475

  • JK providers (Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont) should mail written reopening requests to:

National Government Services, Inc.
P.O. Box 7111
Indianapolis, IN 46207-7111  

Log in to NGSConnex

Appeals Timeline Calculator

J6 Mailing Address:

National Government Services, Inc.

Appeals Department

P.O. Box 6474 | Indianapolis, IN 46206-6474

JK Mailing Address:

National Government Services, Inc.

Appeals Department

P.O. Box 7111 | Indianapolis, IN 46207-7111

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