Many times we are not sure how to correct a submitted Medicare claim(s), which process needs to be followed to get paid from Medicare, there are three types involved to correct Medicare claims.
1) Resubmit
2) Reopen
3) Appeal
Resubmit
If we receive any denials stating CO-16 code that means some information missing in the claim, this type of claims cannot be appealed without resubmitting the omitted information to Medicare .there will be clear indication in denial summary what kind of information Medicare need to be submitted.
Invalid procedure
Need primary insurance EOB
NPI
For the above reason we just need to resubmit the claim with required information, we are not suppose to resubmit in paper, don’t mention corrected claim or second request or resubmitted.
Reopen
Not a major error just typographical error or clerical error or omission, reopen is not applicable when it resulting into an over payment, we can reopen claim through telephone, fax or mail, in many cases reopening is not possible through telephone, if Medicare applies deductible to patient if we want to reopen the claim it should be on written not via any other mode. Medicare follow many rules for reopening a claim.
Telephone reopening
We need to have all the details before call medicare
Provider NPI, TIN,PTAN,DOS, Beneficiary name, claim #.
Appeal
An appeal is a written request to medicare to reconsider the claim, if provider not stratify than he can appeal the claim to medicare , Appeal classified in to five types
1) Redeterminations
2) Reconsiderations
3) ALJ
4) Medicare Appeal Council review
5) Judicial Review in U.S.District Court
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