Scenarios and Coding Instructions for Submitting Requests to Reopen Claims that are Beyond the Claim Filing Timeframes — Companion Information to MM8581: “Automation of the Request for Reopening Claims Process”

When the need for a correction is discovered beyond the claims timely filing limit for an institutional claim, an adjustment bill is not allowed and a provider must utilize the reopening process to remedy the error. Generally, reopenings are written requests for corrections that include supporting documentation. In an effort to streamline and standardize the process for providers to request reopenings, CMS petitioned the National Uniform Billing Committee (NUBC) for a “new” bill type frequency code to be used by providers indicating a Request for Reopening and a series of Condition Codes that can be utilized to identify the type of Reopening being requested. These institutional reopenings must be submitted with a “Q” frequency code to identify them as a Reopening. The NUBC adopted these new codes and bill type frequency change effective with claims received on or after January 1, 2015.