Corporate

August 28, 2014

myCGS Enhancement: Part B Reopenings

myCGS, our web portal for J15 providers, was recently enhanced to accept Part B provider requests for Reopening!

You may request Reopenings to correct minor errors and omissions without going through the formal appeals process. Reopenings may be requested within 12 months of the original claim remittance date to correct minor or clerical errors such as:

  • Mathematical or computational mistakes
  • Transposed procedure or diagnosis codes
  • Inaccurate data entry
  • Misapplication of a fee schedule
  • Computer errors
  • Correct dates of service (within the same year)
  • Adding or changing some modifiers

Please be advised, you may not request a Reopening if the change you are requesting will result in an overpayment; e.g., changing a procedure code to one that has a lower allowed amount than the code that was previously allowed and paid on the original claim.

Also, claims which are rejected as "unprocessable" (remark code MA130 etc.) are not eligible. Claims rejected as "unprocessable" must be corrected and resubmitted as new claims.

For more details on submitting requests for Reopening, please refer to the Reopening vs. Redetermination Job AidPDF. To submit a request for Reopening through myCGS, step-by-step instructions are available to assist you in the Part B provider section of Chapter 7PDF in the myCGS user manual. You will also find details on how to track and check the status of Reopening requests submitted though myCGS.


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