Medicare dme reopening request form

To view field instructions (including CMS supplied instructions, when provided), hover over desired field. Right-click PDF hyperlink and select Save as. REOPENING REQUEST FORM DATA ELEMENT SPECIFIC INSTRUCTIONS Form completion instructions are provided for each data item, which is indicated by a number. Please note that data items are in groups of related information. Note: Unprocessable claims with Remittance Advice (RA) message MA1cannot be reopened.

Before submitting a Reopening request , suppliers must research the claim denial reason (see Standard Paper Remittance (SPR) or Electronic Remittance Advice (ERA), call Interactive Voice Response (IVR), access NMP, or contact Supplier Contact Center) and determine the proper way to correct it. Do not resubmit a claim after submitting a Reopening request. See full list on med. Overutilization denials that require supporting medical records 2. Oxygen break in service (BIS) issues 5. Overpayments or reductions in payment. Medicare Secondary Payer (MSP) issues 7. Claims denied for timely filing (older than one year from initial determination) 7. A good cause for late filing request must be submitted as a Written Reopening request.

Change in liability 10. Recovery Auditor-related items 11. Suppliers may submit a Written Reopening request via mail, fax, or as a Self-Service Reopening in NMP. To submit a Written Reopening special project request , the claim(s) affected must be finalized.

SPR or ERAhas been generated) To avoid a possible dismissal, follow the instructions below. One request form per beneficiary. If supplier has a list of beneficiary c. How do I submit a reimbursement request?

How to request a clerical error reopening? The following forms are designed for DME suppliers who submit claims to CGS. All forms are in the Portable Document Format (pdf). Follow the instructions on the second page to submit the form to your carrier. Submit using myCGS or hardcopy form.

You can also get this form in Spanish. The reopening process will benefit the supplier by identifying appeals that were previously found unfavorable and resolving them favorably in a timely manner. If a case is identified for potential reopening and additional documentation is require MAXIMUS Federal will send the supplier an additional documentation request (ADR) letter. Your next level of appeal is a Reconsideration by a Qualified Independent Contractor (QIC) - Form. PDF download: CMS Manual System – CMS.

Contractors may conduct a reopening to revise an initial determination or redetermination. If this request is due to a Prior-Authorization denial select from the drop down: 1. Are you requesting a Clerical Reopening ? Should recoupment be stopped for a 9overpayment? Visit the CMS Current Emergencies page for information and updates related to COVID-and to access the Accelerated and Advanced Payments Fact Sheet. NOTICE - Anyone who misrepresents or falsifies essential information requested by this form may upon conviction be subject to fine and imprisonment under federal Law.

Timeframes to Complete a Reopening Request by a Party. These forms make it easier for providers to request a redetermination or reopening on a Part B claim and track that request from the date of submission through completion.