Reopenings for Minor Errors and Omissions

Table of Contents

Reopenings for Minor Errors and Omissions

Reopening Facts

What is a Clerical Error?

Clerical Error and Omission Reopening Request

Request a Reopening - NGSConnex

Request a Reopening - In Writing

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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.

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Reopening Facts

• Reopenings are separate and distinct from the appeals process
• Requesting a reopening does not extend nor delay the timeframe to request an appeal
• 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 120 days from the date of the initial determination

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What is a Clerical Error?

A clerical error is defined as a human or mechanical error on the part of the party, such as:

• Mathematical or computational mistake
• Transposed procedure or diagnostic codes
• Inaccurate data entry
• Computer errors
• Incorrect data items

Clerical errors do not include omissions or failure to bill for items or services. Third party payer errors do not constitute clerical errors.

National Government Services encourages providers to initiate electronic adjustments to correct errors or omissions on processed claims, which contain line items denied by automated LCD/NCD edits.

If an electronic adjustment cannot be made (i.e., when the claim has been denied in full) an electronic or written reopening request may be submitted to facilitate the clerical error/omission reopening request process.

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Clerical Error and Omission Reopening Request

• Submit completed Clerical Error/Omission Reopening Request Form
• A note/remark indicating what is to be corrected
• A copy of the corrected UB-04
• Documentation to support the new diagnosis
• Documentation to support that the denied service was rendered
• Itemized bill

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Request a Reopening - NGSConnex

You can submit your reopening requests using our free, secure internet portal, NGSConnex. Follow the step-by-step instructions in the NGSConnex User Guide to initiate your reopening.

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Request a Reopening - 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.