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September 5, 2023

NEW Process for 56900 Reopening Requests

To ensure your 56900 reopening requests are routed and handled efficiently, please use one of these options to submit the appropriate request form and documentation:

  • myCGS (preferred method): The myCGS portal allows you to easily identify claim status, access and complete the appropriate request form, attach documentation, and submit your request electronically. Reference the myCGS User Manual for detailed instructions.
  • 56900 Reopening Request Form: If you still use fax or mail, complete the new 56900 Reopening Request formPDF and send it with a copy of the ADR letter and requested documentation.

What is a 56900 denial?

When a claim is selected for medical review, the contractor sends an additional documentation request (ADR) letter to the provider. If the medical review contractor does not receive the medical record documentation within the required timeframe (45 calendar days for CGS), the claim denies with reason code 56900.

When should I request a 56900 reopening?

You may request a "56900 reopening" if the claim denial date is within 120 days of the request. The Medical Review department will complete the review without utilizing the Medicare Appeals process.

If the claim denial date is greater than 120 days, complete and submit the Redetermination Request form for the first level of appeal.


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