Part B Telephone Reopenings – August 1, 2011, New Hours

Effective August 1, 2011, the hours of operation for Part B Telephone Reopenings will change to the following new hours:

Part B Telephone Reopenings
Monday – Friday
9 a.m. – noon and 1–4 p.m. CT

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.

Comments

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