July 28, 2022
Clerical Error Reopening Reminders
CMS defines clerical errors (including minor errors or omissions) as human or mechanical errors on the part of the party or the contractor, such as:
- Mathematical or computational mistakes,
- Transposed procedure or diagnostic codes,
- Inaccurate data entry,
- Misapplication of a fee schedule,
- Computer errors; or,
- Denial of claims as duplicates which the party believes were incorrectly identified as a duplicate,
- Incorrect data items, such as provider number, use of a modifier or date of service.
Note that clerical errors or minor errors are limited to errors in form and content, and that omissions do not include failure to bill for certain items or services.
The CGS Claims Team has identified issues with providers billing Clerical Error Reopenings. Please remember to do the following when it’s appropriate to submit a Clerical Error Reopening:
- Submit with the correct Type of Bill (TOB)
- Submit with the correct denied Document Control Number (DCN)
- Bill with the D9 condition code.
The following resources are available to assist with guidance and instructions related to the Reopening process.