Saturday, June 23, 2012

Minor errors or omissions outside the appeals process FAQ

Can minor errors or omissions be corrected outside of the appeals process?

A. 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

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