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.

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INDUSTRY NEWS TAGS: Novitas Solutions, MAC JL MAC Delaware, MAC JL MAC District of Columbia, MAC JL MAC Maryland, MAC JL MAC New Jersey, MAC JL MAC Pennsylvania, MAC JH MAC Arkansas, MAC JH MAC Colorado, MAC JH MAC Louisiana, MAC JH MAC Mississippi, MAC JH MAC New Mexico, MAC JH MAC Oklahoma, MAC JH MAC Texas

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