Intent to Reopen a Denied Claim

May 17, 2018
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Rick Gawenda
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The Centers for Medicare and Medicaid Services (CMS) has issued instructions for Medicare Administrative Contractors (MACs) to provide notification of the reopening process and to notify the provider or supplier of their intent to reopen a specific claim when requested documentation is received after a denial of the claim has been made.

If the MACs receive the requested information from a provider or supplier after a denial has been issued but within a reasonable number of days (generally 15 calendar days after the denial date), they have the discretion to reopen the claim. MACs who choose to reopen a specific claim shall notify the provider or supplier of their intent to reopen that claim. Notification to the provider/supplier of the intent to reopen a specific claim shall be completed through any of the following mechanisms: Interactive Voice Response (IVR), contractor website portal, telephone contact, by letter, fax, email or secure messaging within 3 business days of identification of the request to reopen or receipt of medical record documentation.

Click HERE to read the instructions straight from CMS so you, the therapy provider, will know your rights if this occurs to you.


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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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