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/HIC number changes
  • Medical Unlikely Edit (MUE) denials, exceeding the MUE limit (Note: Must file a Redetermination with supporting documentation)
  • Providers who are receiving payment adjustments (reductions) as a result of CMS reductions, such as: Electronic Prescribing (eRx), Electronic Health Record (EHR), Physician Quality Reporting System (PQRS), or CMS Legislative must contact CMS directly for these reductions.

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