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Last Modified: 3/31/2011
Location: FL, PR, USVI
Business: Part B
Claim information change
This inquiry is related to requests through customer service for clerical error reopenings of claims.
• Great News: Clerical reopenings of most single-line claims can now be requested through the IVR. Click here for details on this new time-saving enhancement.
Did you know? Some minor errors or omissions can be corrected by resubmitting the claim with corrected information. To determine if a clerical reopening is the right course for you to take, follow these guidelines:
• Review the type of error or omission you are attempting to correct and select the most efficient option available.
• Resubmitting claims to correct minor clerical errors or omissions is the most efficient method for addressing certain denied services.* Clerical reopenings received via written or telephone requests may take up to 60 days to process and finalize an adjustment to the claim, versus 14-30 days for a resubmitted claim.
• *Resubmit ONLY denied service(s); resubmitting an entire claim will create a duplicate denial.
• Minor clerical errors or omissions which can be corrected and resubmitted include:
• Change to existing diagnosis codes
• Add, change, or delete modifiers (i.e., 24, 25, 50, 59, 78, 79, RT, LT)
• Correcting the place of service (POS)
• Be sure to determine if the error can be corrected and resubmitted prior to writing in or calling the provider contact center to request a clerical error reopening.
• Written or telephone clerical error reopenings are only appropriate for correcting services that were already processed and received an approved amount. This could include corrections to:
• Units or number of services billed
• Submitted charge amount
• Date(s) of service (DOS)
• Certain modifiers, either changing, adding, or deleting
• Procedure codes (excluding codes requiring documentation on initial submission or services being upcoded)
Please use your browser's back button to return to the referring page.Source: FCSO Education Action Team
