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Last Modified: 9/7/2022 Location: FL, PR, USVI Business: Part B

Claim reopening: Accessing the claim FAQ

Q: How do I access a claim I wish to reopen? How will I know if any of the line items associated with a claim are eligible?
A: Before you may initiate the Claim Reopening Request process, you must first access the claim and any of its eligible line items that you wish to correct.
Users may access claims they wish to reopen through two different paths on the SPOT:
Claim Status: Search for the claim based on its Dates of Service or Internal Control Number (ICN)
Claim Reopening: Search for the claim based on its ICN
The SPOT will determine whether a claim or any of its associated line items are eligible for the reopening automatically.
For step by step instructions, please refer to The SPOT: User Guide pdf file

Accessing the claim: ‘Claim Status’ path

Once the claim has been accessed, the SPOT will determine the eligibility of the claim and any of its associated line items automatically.
If you located the claim through Claim Status, view the line item detail: If a line item is eligible, the SPOT will display the hyperlink: View line items eligible for claim reopening above that line item:
Claim Line Item Detail
Note: If a line item is ineligible, the hyperlink will not display above that line item.

Accessing the claim: ‘Claim Reopening’ path

If you searched for an eligible claim by its ICN (i.e., through Claims, Reopen a Claim), the Claim Reopening Inquiry Form will appear and display the claim reopening types selections: Entitlement, Hospice, History Correction, MSP, or Other Corrections. Other Corrections are:
Date of Service
Diagnosis Code (primary)
Procedure Code
Units Billed
Billed Amount
Claims reopening inquiry
If you select Other Corrections, for example, you will be directed to the Claim Reopening Request form.
However, if you searched for an ineligible claim by its ICN (i.e., through Claim Reopening), the following error message will be returned:
Claim reopening: Query
For step by step instructions, please refer to The SPOT: User Guide pdf file
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.