Corporate

January 28, 2015Revised: 09.03.19

Helpful Hints and Reminders

Part B Reopenings may be accepted to correct minor errors and omissions on previously processed claims. When submitting requests to reopen claims, please consider the following helpful hints and reminders:

  • Use the myCGS web portal for optimal experience in filing your reopening request.
  • Reopening requests must be submitted within 12 months of the original claim remittance date.
  • Claims which are rejected as "unprocessable" (remark code MA130 etc.) are not eligible for Adjustments. Rejected "unprocessable" claims are not reviewed for Adjustments and are not considered an "initial or original claim" for the determination of Timely Filing. Claims rejected as "unprocessable" must be re-filed as a new claim.
  • Adding additional lines to a claim which is already processed is not a clerical reopening. Submit the additional lines as a new claim.
  • Duplicate claim file transmissions on the same day will cause all claims to deny. The denied claims cannot be adjusted through the reopenings process. Wait for both claims to complete processing and re-file the claim (as a clean claim).
  • Reopening requests received which are invalid, illegible or inaccurate information cannot be processed and will be returned with a system generated letter.
  • Inquiries will not be accepted if sent as a Reopening. Inquiries must be handled by the Provider Contact Center.
  • Examples of "inquiries" include:
    • Asking for the status of claims or Reopening requests previously submitted
    • Questions regarding denied and/or rejected (Return-to-Provider (RTP)) claims
    • Questions on the amount paid on processed claims
    • Requests to reprocess previously submitted claims without identifying specific error or changes needed
  • Do not send "second" and "third" requests.
  • Check for accuracy PRIOR TO submitting Reopening’s to avoid errors.
    • If erroneous Reopenings are submitted, do not resubmit corrections until the initial request is finalized.
  • Providers who are receiving payment adjustments/reductions as a result of a CMS reduction should contact CMS directly for questions.
  • Request to recoup money on a claim is not a clerical reopening. Submit your request to the Overpayment Recovery Department.
  • Claims which already have an Overpayment recoupment taken are not clerical reopening.
  • Medically Unlikely Edit (MUE) denials which have exceeded the limit due to exceeding the limit should be submitted to the Redeterminations department including the medical documentation.
  • When submitting hardcopy request, access the form online, type and then download and print.
  • For assistance in the difference between a reopening and a redetermination see the Reopening vs. Redetermination Job AidPDF.

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