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When Not to Use Written Reopenings

The following requests cannot be handled by Written Reopenings (not an all inclusive listing):

  • Unprocessable Denials (Remark Code MA-130/Claims without appeal rights)
  • Claims that have demand requests for refund
  • Adding additional line items that were not already billed
  • Requests to recoup money
  • Patient's Name or Identification Number changes
  • Claim inquiries
  • Denials/claims that require a review of documentation
  • Medical Unlikely Edit (MUE) denials, exceeding the MUE limit (Note: Must file a Redetermination with supporting documentation)
  • Providers who are receiving payment adjustments (reductions) because of a CMS program such as the Quality Payment Program External Website. CMS reductions are not handled at the contractor level. Providers should contact CMS directly.

Refer to the Reopening vs Redetermination Job AidPDF for complete information.

Updated: 12.08.23


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