Mon, 12 May 2008 06:56:43 -0400
NHIC, Corp.DME MAC A ListServe
For Immediate Release
May 09, 2008
Telephone Reopenings - ClarificationSuppliers can request to re-open claims=
to correct a minor error or omission caused by the supplier or the=
contractor. The telephone reopening representatives cannot add items or=
services that were not previously billed. Reopenings are granted at the=
contractor's discretion.Suppliers can call the DME MAC A telephone=
reopening number at 317-595-4371 between the hours of 8:00 a.m. and 4:00=
p.m. EST. This is a toll number and, therefore, the number of telephone=
lines are limited to avoid long hold times and unnecessary costs to the=
supplier community. Callers will receive a busy signal rather than being=
placed on hold and should hang-up and try again. If the caller does not=
receive a busy signal and is put on hold, the wait time should be brief, as=
only a minimal number of callers at a time will be placed on hold.=
Currently, the non-peak hours are early in the day and Fridays.The=
telephone reopening process can be used to resolve minor errors or=
omissions involving:Units of service;Service dates;Healthcare Common=
Procedure Coding System (HCPCS) issues;Diagnosis codes and diagnosis=
reference;Modifiers;Place of service; andClaims incorrectly denied as=
duplicate chargesCertain Medicare Secondary Payer (MSP) issues - Note:this=
only applies in situations where the system records have been updated to=
indicate a change in the beneficiary's MSP status and the claim needs to be=
reprocessed as Medicare primary. If system records have not yet been=
updated, the claim cannot be reopened.
Suppliers should not call the telephone reopening line without receipt of a=
Medicare Remittance Advice. No action can be taken until a final claim=
determination has been issued.
Suppliers should consult the DME MAC Jurisdiction A Supplier Manual and=
applicable medical policy guidelines before contacting the telephone=
reopening number to ensure the claim was filed per established=
requirements.
To effectively service all suppliers, each call will be limited to three=
claim issues.
Reopening requests for break in service issues, Certificate of Medical=
Necessity (CMN) or DME Information Form (DIF) issues, and other CMN/DIF=
changes are not permitted. These types of requests usually require a=
supplier to submit copies of CMNs/DIFs, delivery and pick-up information,=
and other documentation before a final determination can be made;=
therefore, these must be submitted in writing through the Appeals process.
If a previous reopening decision has been issued, a redetermination must be=
made in writing. If a previous redetermination decision has been issued, a=
reconsideration must be filed.
The following information must be provided and/or accessible:Beneficiary's=
nameMedicare Health Insurance Claim NumberCaller's nameCaller's telephone=
numberSupplier's nameSupplier's PTAN numberClaim Control NumberDate of=
serviceReason for the requestThe following issues cannot be handled by the=
telephone reopening representative:Redetermination requests, which must be=
submitted via the Appeals processUntimely filingUnprocessable/Returned=
claimsMost Medicare Secondary Payer (MSP) issues - Reopenings only apply in=
situations where the system records have been updated to indicate a change=
in the beneficiary's MSP status and the claim needs to be reprocessed as=
Medicare primary. If system records have not yet been updated, the claim=
cannot be reopened.Any claim that requires additional=
documentationLimitation on liability issues (inquiries regarding a missing=
GA modifier)Inquiries on the status of a claim(s)Inquiries related to=
denial of payment based on entitlementQuestions that are general in nature=
and not claim specificReopenings requests for break in service issuesCMN or=
DIF issues or changesIn addition to the telephone reopening process,=
requests can also be faxed, using the Reopenings Cover Sheet, to=
781-741-3914.Claims which must follow the first level of the Appeals=
process should be filed for a redetermination at the following address:
DME Redeterminations
P.O. Box 9150
Hingham, MA 02043-9150Questions concerning any of the topics listed below=
should be directed to the Interactive Voice Response (IVR) system and/or a=
Customer Service representative:Inquiries on the status of a claim(s) (IVR=
only)Inquiries related to denial of payment based on entitlementQuestions=
that are general in nature and not claim specificUnprocessable/Returned=
claimsIVR: 866-419-9458Customer Service Representative: 866-590-6731 -=
Note:This number is only to be used for issues that cannot be addressed by=
the IVR.Additional information regarding Customer Service and the telephone=
reopenings functions can be found on the "Contacts" page of the DME MAC A=
Web site at http://www.medicarenhic.com/dme/contacts.shtml.
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