Automation of the Request for Reopening Claims Process

September 2, 2014
Rick Gawenda

The Centers for Medicare and Medicaid Services (CMS) have issued instructions in changes to the Reopening process for non-private practices (i.e. institutional settings). These changes were necessary due to a non-standard approach of requesting a Reopening from one Medicare Administrative Contractor (MAC) to another. In an effort to streamline and standardize the requesting process, CMS has petitioned the National Uniform Billing Committee (NUBC) for a “new” bill type frequency code that can be used by providers to indicate a Request for Reopening and a series of Condition Codes that can be utilized to identify the type of Reopening being requested. Upon adoption of these NUBC changes, CMS can move forward with implementation of necessary system changes to accommodate this process. To read the full instructions and obtain access to supplemental handouts that includes the effective date for implementation as well as the new required condition codes and their definitions, click

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