Reopenings for Minor Errors and Omissions

Providers may request a reopening of the original claims processing decision by contacting the TRU.

The TRU can be used when you wish to revise the initial determination of a specific service or claim for minor clerical errors.

TRU representatives will reopen claims to correct minor, uncomplicated, provider or carrier clerical errors or omissions. However, TRU representatives cannot add items or services that were not previously billed.

Note: Reopenings are granted at the contractor’s discretion.

With the availability of the ERA, you can know the outcome prior to the complete finalization of a claim. Please make sure the claim has finalized prior to calling the TRU line to request changes to the claim.

Note: Unsolicited faxes will be returned to the sender without being processed.

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.

When submitting a request for correction of 25 or more for the same or similar situation, please complete a Part B Reopening Request Form and attach the Large Various Adjustment Macro (LVAM) form. This form will help to ensure that the correct claims are identified for the adjustments being requested. This also prevents us from having to contact your office for further clarifications. Examples of like services that can be corrected through our LVAM process are: changing modifiers or procedure codes, adding diagnosis codes, increasing billed amount, changing the place of service, and changing the quantity billed.

Request a Reopening

We recommended using our online portal, NGSConnex.

NGSConnex is a free and secure web-based application, has a convenient option available that providers can use to submit an appeal request for a claim redetermination or reopening online instead of submitting a paper appeal. Providers can also check the status of redeterminations/reopening requests.

In Writing

You can submit a written request by completing and mailing a Part B Reopening Request Form.

J6 providers (Illinois, Minnesota and Wisconsin) should mail written reopening requests to:

National Government Services, Inc.
P.O. Box 6475
Indianapolis, IN 46206-6475
JK providers (Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont) should mail written reopening requests to:

National Government Services, Inc.
P.O. Box 7111
Indianapolis, IN 46207-7111

Contacting the TRU

Visit Reopening versus Redetermination for specific TRU inquiry details.

TRU representatives are available:

Monday‑Friday: 8:00 a.m.-4:00 p.m. (CT/ET)
Closed for training on the 2^nd and 4^th Friday of the month:
12:00‑4:00 p.m. ET/11:00 a.m.‑3:00 p.m. CT

Please be prepared to provide the following information when you call the TRU:

Beneficiary’s name
Medicare HICN or MBI
Your name
Your phone number
Provider’s full name (The provider’s name will be listed on the Medicare remittance advice.)
PTAN
Item or service in question
Date(s) of service in question
Reason for the request

What Number Do I call?

J6 TRU: 877-867-3418

Illinois: Press 1
Minnesota: Press 2
Wisconsin: Press 3

JK TRU: 888-812-8905

New York: Press 1
Connecticut: Press 2
Maine: Press 3
New Hampshire: Press 4
Vermont: Press 5
Rhode Island: Press 6
Massachusetts: Press 7