Telephone reopening requests via the IVR

The First Coast Part B interactive voice response (IVR) allows providers / customers to request telephone reopenings on certain claims.

Features

• This enhancement is designed to make your requests easier and faster to process. Requests for telephone reopenings via the IVR will process the next day.
• Using this self-service feature will result in faster receipt of any applicable payments.
• The hours of availability are beyond the hours of availability for a customer service representative (CSR).

Types of reopenings available via the IVR

The following types of reopening requests are not available through a CSR; you must call the IVR for the following types of requests:

• Change date of service and quantity billed
• Change diagnosis code
• Add, delete, change modifier (except modifiers listed below)
• History corrections – including entitlement, Medicare Secondary Payer, Medicare Advantage Plan change in status or update to the patients records
• Change procedure code (can also change billed amount)
• Change quantity billed (can also change billed amount)
• Change ordering or referring provider information

Types of reopenings that cannot be performed via the IVR

• Previously adjusted claims
• Pending claims
• Non-assigned claims
• Claims for certain drug codes (listed below)

CPT® / HCPCS drug codes not allowed via the IVR:

• Request on claims containing the following modifiers, or requests to add or change these modifiers: 21, 22, 24, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, or SG, or WU.
• Deleting a 26 modifier when the place of service is equal to 21 or 22. Multicarrier System (MCS) logic will automatically re-apply the 26 modifier to the claim. 

Information you must have when calling the IVR for a reopening

• Provider’s National Provider Identifier (NPI), Tax Identification Number (TIN), and Provider Transaction Access Number (PTAN)
• Beneficiary’s last name and first Initial
• Beneficiary’s Medicare ID
• Beneficiary’s date of birth
• Caller’s name and 10-digit telephone number (3-digit area code and 7-digit number)
• Date of service
• Internal Control Number (ICN) -- can be obtained from your provider remit notice or the IVR when receiving a claim status
• Item(s) or service(s) at issue
• Reason for request
• New / revised information

IVR takes your request -- what's next? 

• IVR will confirm the request at the end of the call.
• If the request is approved, you will receive a new remittance advice notice.
• If the request cannot be processed, a letter will be sent advising the provider of our decision.
• If the request would create an overpayment situation, the IVR will advise you to submit your request via a written redetermination form. 

IVR hours of availability for telephone reopenings

• The IVR is available for requests for telephone reopenings from 7:00 a.m. to 6:30 p.m. Monday through Friday, and Saturday 7:00 a.m. to 3:00 p.m. ET.
• The toll-free Part B telephone number is 1-877-847-4992

Additional information

• No limit to the number of calls per day.
• Please have the information listed under “Information You Must Have When Calling the IVR for A Reopening” available when calling for an IVR reopening.
• Additional IVR instructions are available via our IVR Part B operating guide.