Reopenings for Minor Errors and Omissions

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 [...]

Reopening Request Timeframes

Reopening Request Timeframes According to the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 34, Section 10.6.2, Timeframes for Party Requested Reopenings: A party may request a contractor reopen and revise its initial [...]

ALJ Hearing

ALJ Hearing The third level of appeal is an ALJ hearing. Time limit to initiate = 60 days from the date of receipt of reconsideration (QIC decision) Time limit to complete the review = 90 days Amount in controversy = The amount that must [...]

Federal Court Review

Federal Court Review The fifth level of appeal is carried out by the Federal District Court (U.S. District Court). Time limit to initiate = 60 days from date of receipt of Medicare Appeals Council decision Amount in Controversy = The [...]

MLN Connects® Newsletter: November 21, 2024

MLN Connects® Newsletter: November 21, 2024 News Medicare-Funded Physician Residency Positions CMS Roundup (November 15, 2024) Hepatitis B Vaccine: Billing Requirement Update Effective January 1 Hospitals: Use Renewed Beneficiary Notices [...]

Prolonged Preventive Services

Preventive Services Guide Prolonged Preventive Services Effective for claims with dates of service on or after 1/1/2018, prolonged preventive services will be payable by Medicare when billed as an add-on to an applicable preventive service [...]

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)

Obtaining Beneficiary Eligibility Information Through NGSConnex

Obtaining Beneficiary Eligibility Information Through NGSConnex  As a reminder, our Customer Service Representatives aren’t permitted to share eligibility information because it’s available through NGSConnex. If you need help, we [...]