Appeal Submission Process for Claims with Multiple Line Items
We have identified instances where providers are submitting several appeals for one claim internal control number.
If you need to appeal (redetermination) a claim with multiple line items containing redeterminations and/or reopenings:
- Review the entire ICN
- Determine the line item Reopening Versus Redetermination
| If a single claim contains | Then |
|---|---|
| Line items that are a mix of reopenings and redeterminations | Submit one redetermination for all lines in question |
| Line items that are redeterminations | Submit one redetermination for all lines in question |
| Line items that are clerical error reopenings | Submit one reopening for all lines in question |
Providers are responsible for knowing the difference between clerical error reopenings and the redeterminations processes. To ensure you have a clear understanding, we are hosting the following open forum for Part B providers and staff members. This session will offer you an opportunity to receive answers to the questions you have about the redetermination and reopening process. We hope you will join us; register below.
Posted 1/21/2020