Change to Procedure for Making Corrections for Automated LCD/NCD Denials

Effective June 1, 2012, NHIC, Corp. will accept provider-initiated Clerical Error Reopening requests for claims that have been fully or partially denied by automated edits for National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs). As of that date, it will no longer be necessary to submit an appeal request to NHIC, Corp. to adjust these claims, to add or change diagnosis codes, or to make other revisions to the claim data. The NHIC Reopening Form has been updated to include this new request reason. Please note this change does not apply to claims that have been denied through post-payment or pre-payment processes by NHIC, Corp., or by other entities such as a Recovery Audit (RA), Program SafeGuard Contractor (PSC), Zone Program Integrity Contractor (ZPIC), or Comprehensive Error Rate Testing contractor (CERT). The appeals process must be used for claims denied through post-payment reviews. NHIC (National Heritage Insurance Company) J14 MAC for Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont

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