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Thread: Medicare Corrected Claims

  1. #1

    Question Medicare Corrected Claims

    AAPC: Back to School
    Does anyone know how long you have to correct a claim with Medicare AFTER you have already received payment? I have some claims that should have had modifiers and after receiving payment, we realized the error and would like to correct them.

  2. #2

    Default rejected claims

    We've all had the same issue. You can fax or mail a reopening form to Trailblazer. I'm sure that your medicare carrier has the same procedure for correcting administrative errors.

    What is a Reopening?

    A reopening is not an appeal right. It is an action taken to correct an error in response to suspected fraud, an error made by official sources, clerical errors or in response to the receipt of information not available or known to exist at the time a decision was issued for a service.

    Conditions and Time Frames for Reopenings

    Reopenings are limited to the specific time frames and conditions listed below:

    Up to 12 months after the initial determination or redetermination date for any reason.
    Twelve months to four years for “good cause.”
    “Good cause” must be established to perform a reopening. “Good cause” exists when:
    New and material evidence is presented that was not readily available at the time of the redetermination.
    There is an error on the face of the evidence on which the decision was based or there was a clerical error in the claim file.
    Any time an inquiry brings to attention an obvious error in the claim decision based on the information in the record or the error resulted from a claim processing error.
    Any time the determination or redetermination decision was procured by fraud or similar fault.

    For information about how to request a reopening, please select the appropriate Part A or Part B link below.

  3. #3

    Smile Jobs

    Hi there my name is Linda i am looking for work,I was working but that job is over the Dr. went close her office so here i go look again can someone tell me where some work is.

  4. #4
    Join Date
    Apr 2007
    Boardman, Ohio

    Default LDALLAS-Post in correct forum

    please post in the correct forum- you may get more responses.. you want to put this in the RESUME one.
    Julie S., CPC
    Anesthesia Coder
    Education Officer, Cleveland Area Chapter 2016
    Email: medcoder05@gmail.com

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