Redetermination/Reopening Requests Online with NGSConnex

The NGSConnex web application allows providers/suppliers the ability to electronically submit and check the status of all redeterminations and/or reopenings requests online with no costs involved.

Submit a Request and Attach Supporting Documentation

To submit a redeterminations or reopenings requests through the NGSConnex system, follow the steps below. Once you are setup and logged into the NGSConnex system, this process is simple and easy to use.

1. Click on the My Claims tab
2. Click on the select button next to the appropriate PTAN/NPI
3. Select “claims” in the Claim Type drop down box and click on “Go”
4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (or first initial), Beneficiary Date of Birth (MMDDYYY or MM/DD/YYYY). You can narrow your search by entering from service date, to service date and/or claim number if you wish.
5. Click the Load Claims button.
6. Locate the claim you wish to initiate a redeterminations or reopenings and click on the Claim Number.
7. Click the Initiate Redeterminations/Reopening button
8. Complete the Redeterminations/Reopening form. All fields with a 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 do not 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 redeterminations or reopenings, click 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.

Check the Status

To check the status of a redeterminations or reopenings requests through the NGSConnex system, follow the steps below.

1. Click on the My Claims tab
2. Click on the select button next to the appropriate PTAN/NPI.
3. Select “claims” in the Claim Type drop down box.
4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (or first initial), Beneficiary Date of Birth (MMDDYYY or MM/DD/YYYY) and Claim Number.
5. Click the Load Redetermination/Reopening Status button.
6. The status will display at the bottom of the screen.

NGSConnex will display the status whether it is pending or finalized and will include all redeterminations/reopenings requests regardless of how they were originally initiated (written, fax, telephone or NGSConnex). When a review has been completed, the system will display a “finalized” status and status description. When a review is still being conducted, the status will display as “pending.” The date the request was received will display and the review can take up to 60 days to complete.

Not using NGSConnex yet?

Not only does NGSConnex allow you to submit and check the status of all redeterminations/reopenings requests, but it has many self-service functions that can save you time. If you do not currently have NGSConnex access, follow the setup instructions available in the NGSConnex User Guide available within the NGSConnex section of our website. In addition to the information provided above, NGSConnex offers many other time-saving options, including;

• Query for claims status
• View supplier demographic information
• Obtain same/similar information for DME MAC suppliers
• Query financial data
• Order duplicate remittances
• Query beneficiary eligibility/entitlement

There are no costs associated with using NGSConnex. All you need is Internet access and an email address. So sign up and start using NGSConnex today!