Thursday, March 17, 2016

cliam reopening via IVR - Medicare

Telephone reopening requests via the IVR

The First Coast Service Options’ Part B interactive voice response (IVR) allows providers/customers to request telephone reopenings on certain claims.


• This enhancement is designed to make your requests easier and faster to process. Requests for telephone reopenings via the IVR will process the next day.

• Using this self-service feature will result in faster receipt of any applicable payments.

• The hours of availability are beyond the hours of availability for a customer service representative (CSR).

• Bonus -- The number of telephone reopening requests via the IVR are unlimited within the allotted 30-minute timeframe.

Types of reopenings available via the IVR

The following types of reopening requests are not available through a CSR; you must call the IVR for the following types of requests:

• Change date of service and quantity billed
• Change diagnosis code
• Add, delete, change modifier (except modifiers listed below)
• History corrections – including entitlement, Medicare Secondary Payer, Medicare Advantage Plan change in status or update to the patients records
• Change procedure code (can also change billed amount)
• Change quantity billed (can also change billed amount)
• Change ordering or referring provider information
Types of reopenings that cannot be performed via the IVR
• Previously adjusted claims
• Pending claims
• Non-assigned claims
• Claims for certain drug codes (listed below)

CPT®/HCPCS drug codes not allowed via the IVR
J0200 J0390 J0395 J0520 J0735 J1094 J1700
J1710 J1885 J1960 J1990 J2323 J2440 J2670
J2760 J3490 J3590 J7130 J7184 J7199 J7310
J7326 J7628 J7629 J7648 J7658 J7659 J7683
J7684 J8499 J9165 J9201 J9217 J9219 J9270
J9357 J9999 Q0144 Q2027 Q2034 Q2035 Q2036
Q2037 Q2038 Q2039 Q2045 Q2046 90654 90655
90656 90657 90658 90659 90660 90667 90668
90715 90724 90779 96549

• Request on claims containing the following modifiers, or requests to add or change these modifiers: 21, 22, 24, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, or SG, or WU.
Information you must have when calling the IVR for a reopening
• Provider’s National Provider Identifier (NPI), Tax Identification Number (TIN), and Provider Transaction Access Number (PTAN)
• Beneficiary’s last name and first Initial
• Beneficiary’s Medicare health insurance claim (HIC) number
• Beneficiary’s date of birth
• Caller’s name and 10-digit telephone number (3-digit area code and 7-digit number)
• Date of service
• Internal Control Number (ICN) -- can be obtained from your provider remit notice or the IVR when receiving a claim status
• Item(s) or service(s) at issue
• Reason for request
• New/revised information

IVR takes your request -- what’s next?
• IVR will confirm the request at the end of the call.
• If the request is approved, you will receive a letter and new remittance advice notice.
• If the request cannot be processed, a letter will be sent advising the provider of our decision.
• If the request would create an overpayment situation, the IVR will advise you to submit your request via a written redetermination form.

IVR hours of availability for telephone reopenings
• The IVR is available for requests for telephone reopenings from 7:00 a.m. to 6:30 p.m. Monday through Friday, and Saturday 7:00 a.m. to 3:00 p.m. ET.
• The toll-free Part B telephone number is 1-877-847-4992

Additional information
• No limit to the number of calls per day.
• Please have the information listed under “Information You Must Have When Calling the IVR for A Reopening” available when calling for an IVR reopening.
• Additional IVR instructions are available via our IVR Part B operating guide.

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