Claim Reopening Decision Letters

Effective February 27, 2017, Novitas Solutions will consider a corrected claim reopening notification satisfied with a corrected Remittance Advice (RA). A Clerical Error Reopening (CER) decision letter will no longer be issued when the reopening determination results in one of the following: Services in question remain denied; resulting in a revised denial; Services in question result in partial payment increase; some services allow, while the rest remain denied or Payment/denial does not change. A CER decision letter will be issued if the claim correction results in a change in liability or an over allowance. CER notification based on the claim corrections will be reflected on the revised RA. You have the right to request a redetermination if you do not agree with how the claim processed. The redetermination must be requested in writing within 120 days of the date the revised claim finalized.