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Initiate Part B Reopenings or Non-MSP Overpayment Adjustments in NGSConnex

Did you know that you can save time and money by requesting a Part B clerical error reopening electronically via NGSConnex? You will save time because electronic submission is much quicker than paper submission by mailing and you will save money by cutting postage fees.

Initiate an NGSConnex Reopening 

A reopening is a request for a claim adjustment due to a minor error or omission on the original claim. Many types of claims may be adjusted through an NGSConnex reopening without the need to submit an appeal through the redetermination process. You may adjust claim level details, line of service information or indicate a claim was billed in error.

Using NGSConnex to reopen a claim or initiate an adjustment due to an overpayment is quick and easy, just follow these simple steps:

  1. Click the My Claims tab, locate and select the claim you would like to reopen
  2. Click the Initiate Reopening button in the Claim Lines panel
  3. Complete the Medicare Reopening form and make necessary changes including claim level and/or line level
  4. Submit your request by clicking the OK button

You will receive a confirmation email from to confirm your submission.  

Note: A final claim determination must be issued on the original claim before you can initiate a reopening. 

Examples of minor error or omissions that may be adjusted through NGSConnex include: 

  • Billed amount
  • Date last seen
  • Date of service – must be within the same calendar year
  • Diagnosis code additions or changes
  • Medicare ID – initiate a billed in error adjustment using the NGSConnex reopening process and then resubmit a corrected claim
  • MUE – only if the MUE is not exceeded
  • Modifier additions or changes (except for modifiers 22, 23, 52, 53, 62, 66, GA, GY or GZ which require a redetermination request (with supporting documentation)
  • Place of service
  • Procedure codes
  • Ordering/referring/supervising provider
  • Rendering provider – must be associated to the billing provider
  • Units of service

Note: Clerical errors do not include omissions or failure to bill for items or services. You cannot add items or services that were not previously billed. Third party payer errors do not constitute clerical errors.  

Initiate a Non-MSP Overpayment Adjustment  

If you billed a claim or claim line in error and received payment, initiate an overpayment adjustment using the Initiate Reopening feature in NGSConnex. You may adjust a line of service or you may indicate the entire claim was billed in error by simply clicking a checkbox.

If you have completed the one-time request to have all current overpayment(s) and future overpayment(s) satisfied via immediate recoupment, you will not need to complete additional steps related to the provider initiated overpayment. This  process will also help you avoid interest from accruing on claim(s) overpayments. If you have not previously requested an immediate recoupment, you will receive a demand notice for the overpayment.  

Watch this five-minute tutorial to learn how to initiate an NGSConnex reopening:

Revised 10/24/2018
Posted 5/18/2018

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CPT codes, descriptions, and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All rights reserved. Applicable FARS/DFARS apply.

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