Corporate

Reopenings Reprocess Claim Adjustment Request Form (REP 913)

Form REP 913PDF(Reopenings Reprocess Claim Adjustment Request Form) will allow you to submit a request to reprocess a claim that denied when there are no changes or updates to make to the actual claim. Examples include:

NON-MSP

  • Update to fee schedule or update to allow new procedure codes.
  • Global surgery denials that should be reversed due to an update to a different claim.
  • An erroneous duplicate denial. NOTE: Make sure the duplicate denial is incorrect; otherwise the adjustment may result in payment errors and/or recoupments.

MSP

  • A patient's file was updated to show Medicare should pay as primary on a claim we originally processed and denied as secondary.
  • Includes Medicaid timely filing claims.

Only one claim can be corrected per form.

NOTE: In order to complete the form accurately, you must have access to your Remittance Advice (RA). If you download your RA from a billing service or clearinghouse, the line items may be in a different sequence, which will affect the processing on this form. We suggest accessing your RA directly from the myCGS Web Portal.

Also, to avoid issues with legibility, we encourage you to complete the form online, and then print it.

Automated Reopenings Reprocess Claim Adjustment Request Form Instructions

  1. Complete the Header of the form:

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    • Select the State
    • Enter the date the form is completed
    • Enter a contact person's name and telephone number

    NOTE: This information is important should we need to contact you with a question regarding your Reopening request.

  2. Complete the Provider Information section:

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    • Enter the Provider's Name
    • Identify the last 5 digits of Tax ID number
    • Enter the Billing PTAN
      • Individual physicians/practitioners who reassign benefits to a group, enter the Group PTAN
      • Solo physicians/practitioners, enter the Individual PTAN.

  3. Complete the Beneficiary Information section:

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    • Enter the Beneficiary's Name
    • Enter the Beneficiary's Medicare ID
      • To avoid processing delays, please verify that the Medicare ID is correct.

  4. Identify the claim information:

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    • Enter a Date of Service from the claim.
    • Identify a HCPCS/CPT code (procedure code) that corresponds to the date of service.
    • Enter the Internal Control Number (ICN) of the claim, which is located on the RA. 
      • Verify that the ICN is accurate. Incorrect, incomplete, or invalid ICNs will result in increased processing time (up to 60 days).

  5. Complete the Adjustment Details section:

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    • Check the appropriate box:
      • Select Medicare Secondary Payer (MSP) when Medicare is now the primary payer on a claim originally processed as secondary.
      • Select Non-MSP for all other requests.

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