skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. Information for Medicare beneficiaries is only available on the medicare.gov website.
En Español
Text Size:
Close
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 10/14/2018 Location: FL, PR, USVI Business: Part B, Part A

Claim reopening: Request types FAQ

Q: What types of changes may I include in a claim reopening request? May I change more than one field on each line item? Can I add or remove line items?
A: Part A providers may use SPOT to submit a request for clerical corrections to eligible line items in your Part A claim. Providers must submit any accompanying documentation along with the CMS-1450 (UB-04) form pdf file.
Part B providers may conduct a clerical claim reopening through the SPOT with the ability to make corrections to the following fields:
• Date of Service (DOS)
• Diagnosis Code (primary)
• Procedure Code
• Modifier
• Units Billed
• Billed Amount
• In addition, there are two other request types available: Hospice, where modifier GV or GW may be added, and History Correction, where the claim may be submitted without any changes.
• Only one claim reopening request type may be selected for each eligible line item, and the type of request is determined by the primary field to be corrected.
• Some types of requests may allow the editing of more than one field (i.e., primary and secondary fields). However, the primary field is based upon the request type selected, and the primary field is always a required field.
• Some modifiers and procedure codes are ineligible for clerical claim reopening through SPOT.
Request types

Claim Reopening: Request types and tips

Claim reopening request type
Primary field(s) (required)
Secondary field (optional)
Comments
Hospice
Add Modifier
N/A
Modifier GV or GW is required
History Correction
N/A
N/A
Submitting with no changes
To access the following reopenings, select Other from the drop-down menu
Edit DOS From
DOS From
N/A
DOS From date may not be later than DOS To date.
Edit DOS To
DOS To
N/A
DOS To date may not be earlier than DOS From date
Edit DOS Both
DOS From
and DOS To
N/A
Both fields must be changed
Edit Diagnosis Code
Diagnosis Code
N/A
The primary diagnosis code may be changed.
Edit Procedure Code
Procedure Code
Billed Amount
The replacement code must be one that may be used in a claim reopening request.
Add Modifier
Modifier
(first available field)
N/A
Only one modifier may be added, and it must be one that may be used for a reopening request.
Edit Modifier
Modifier
(any modifier field that contains a value)
N/A
Only one modifier may be replaced, and it must be one that may be used for a reopening request.
Delete Modifier
Modifier
(any modifier field that contains a value)
N/A
Only one modifier may be deleted.
Edit Units Billed
Units Billed
Optional fields: DOS From, DOS To, Billed Amount
Anesthesia providers must use units and not minutes when adjusting units billed. The conversion factor is 1 unit = 15 minutes. For example, 75 minutes would be entered as 5 units (75/15=5 units).
Edit Billed Amount
Billed Amount
N/A
Note: An adjusted billed amount that is less than the allowed amount for the service is not accepted as it may result in an overpayment.

Limitations to claim reopenings on the SPOT

• Multiple request types (e.g., Edit Procedure Code and Add Modifier) may not be utilized for the same eligible line item
• Line items may not be added or removed
• Certain corrections (e.g., updates to beneficiary information or status) may not be submitted
• Rendering provider’s NPI may not be changed
• Claim reopening requests submitted through the SPOT must be filed within one year of the receipt of the initial determination
• Multiple modifiers, procedure codes, or diagnosis codes may not be added through the SPOT
For step by step instructions, please refer to The SPOT: User Guide pdf file
list item Please use your browser's back button to return to the referring page.
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.