Can minor errors or omissions be corrected outside of the appeals process?
Yes. A clerical error reopening can be initiated via the telephone or in writing; or, in many cases, the denied service(s) can simply be resubmitted. Resubmitting claims to correct minor clerical errors or omissions is the most efficient method for addressing certain denied services.*
*Resubmit the denied service(s) ONLY - resubmitting an entire claim will create a duplicate denial.
If these issues are received via written and telephone requests, it may take up to 60 days to process and finalize an adjustment, versus 14-30 days for a resubmitted claim. Ensure that you review the type of clerical error or omission you are attempting to correct and select the most efficient option available.
Note: Single-line clerical reopenings can now be requested through the Part B Interactive Voice Response unit (IVR).
Determine if the error can be corrected and resubmitted prior to writing in or calling to request a clerical error reopening.
• Minor clerical errors or omissions that can be corrected and resubmitted:
• Change of diagnosis codes
• Add, change, or delete modifiers (e.g., 24, 25, 50, 59, 78, 79, RT, LT)
• Incorrect place of service
• Written or telephone clerical error reopenings are appropriate only for services that were processed and received an approved amount, and could include the following types of situations:
• Number of services (NB) billed
• Submitted charge amount
• Date of service (DOS)
• Add, change or delete certain modifiers
• Procedure code; excluding codes requiring documentation on the initial submission or codes being upcoded
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
CPT CODE and description 90460 - Immunization administration through 18 years of age via any route of administration, with counseling by ...
CPT CODE and Description 97001 - Physical therapy evaluation Average fee payment $70 - $80 97002 - Physical therapy re-evaluation Ave...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
CPT CODE and Description 90785 - Interactive complexity (List separately in addition to the code for primary procedure) 90791 - Psychi...
Here is the big list of Medical terminology abbreviation @—at A & P—anatomy and physiology ab—abortion abd—abdominal ABG—arterial ...
Place of Service: A two-digit code used on health care professional claims to indicate the setting in which a service was provided. Place...
Complete Blood Count (CBC) Testing A complete blood count consists of measuring a blood specimen for levels of hemoglobin, hematocrit, red...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...