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Part B Clerical Error Reopenings Process
08/03/09 - Corrected Claims
- Reference Numbers for Clerical Error Reopenings (CERs)
- Clerical Error Reopenings (CER)
- Clerical Error Reopenings Requirements
- Clerical Error Reopenings Toll-Free Numbers
- Part B Clerical Error Reopenings Process
Reference Numbers for Clerical Error Reopenings (CERs)
Cahaba has received comments and questions regarding why the CER Department does not give providers a reference number when they call to have their claims reopened. This has never been a practice of this department. You will receive a Remittance Advice Notice for each reopening request. It will inform you of payment of the claim or of a denial. It is not necessary to have a reference number for a reopening. When you are checking the status of a claim via the IVR any ICN which begins with a region code of 46, 48, 57, or 83 indicates an adjustment/reopening was completed on that claim.
Clerical Error Reopenings (CER)
A Clerical Error Reopening (CER) is a simple/minor correction to a claim regardless if the error or omission was made by a provider or by Cahaba GBA. The fastest, most efficient and cost effective way to correct your claim is via the telephone. Claims are reopened while you are on the telephone with the analyst and payment is received faster for a telephone reopening than a reopening submitted via paper. Providers may call our toll free lines for telephone clerical error reopenings by calling the telephone numbers at the bottom of this page.
You may also request a Clerical Error Reopening in writing by submitting the Cahaba GBA Clerical Error Reopening Request Form. Do not use this form to submit Redeterminations (Appeals). Examples of clerical error requests are listed on the form. The Centers for Medicare and Medicaid Services allows Contractors 60 days to adjudicate a Clerical Error Reopening.
| Clerical Error Reopenings | Criteria Necessary | Time Limits |
|---|---|---|
| Clerical Error Reopenings | The Benefits & Protection Act of 2000 (BIPA) requires Contractors to provide a mechanism for providers to telephone simple and/or minor corrections to denied claims. (See Clerical Error Reopenings section below) | Effective January 01, 2006, Must be requested within one year of the initial determination. |
Clerical Error Reopenings Requirements
If you are requesting a Clerical Error Reopening over the telephone, the following items are required:
- The beneficiary name;
- The beneficiary's Health Insurance Claim Number (HICN);
- The beneficiary's date of birth;
- The date of service (DOS); and
- The total amount billed.
The following examples listed are some of the Clerical Error Reopening requests that can be handled over the telephone in most cases:
- The diagnosis was not linked properly on the original claim,
- The number of services or units is incorrect or missing,
- The anesthesia time is missing,
- The date of service is incorrect (except for changes to the year),
- The CPT code is incorrect, and changing it will not create an overpayment,
- The services are incorrectly denied as duplicate charges,
- A modifier is being added or corrected (except for Returned Unprocessable Claim (RUC) - MA-130 denials),
- The place of service is incorrect,
- Injection name and dosage (for miscellaneous codes); and
- Ambulance services to add modifier GW only when denied for hospice care.
The following examples listed are some of the Clerical Error Reopening requests that cannot be handled over the telephone in most cases:
- Returned Unprocessable Claims (RUC) - MA-130 denials
- Claims with five or more surgeries
- Ambulance services denied for medical necessity
- Chiropractic services
- Podiatry services, regardless of provider specialty
- Concurrent Care denials
- Frequency denials
- Surgeries billed out sequence or on two separate claims
- Medicare Secondary Payer (MSP) claims
- Claims that have been offset or a request for a refund has been received
- Changes in HICN and/or beneficiary's name
The numbers to call for Clerical Error Reopenings are listed below. When you call, please have all the required information ready for the analyst to assist you. Please limit your requests to three per call. These lines are dedicated to simple Clerical Error Reopenings only. Please call your Provider Contact Center for general inquiries.
Clerical Error Reopenings Toll-Free Numbers
- Cahaba GBA - Alabama Medicare Part B - 888 391-8840
- Cahaba GBA - Georgia Medicare Part B - 866 582-3244
- Cahaba GBA- Tennessee Medicare Part B- 888 391-8840
- Cahaba GBA - Mississippi Medicare Part B - 888 836-7932
The toll-free telephone lines are available from:
- 9:00 a.m. EST through 4:00 p.m EST
Beginning at 3:45 p.m. EST the analysts will take only one Clerical Error Reopening request per call in order to allow us to reach providers who may have been on hold for an extended length of time.
