Reopenings for Minor Errors and Omissions

Table of Contents

• Reopenings for Minor Errors and Omissions
• 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.

• 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

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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.

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.

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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.