cliam reopening via IVR - Medicare

Telephone reopening requests via the IVR

The First Coast Service Options’ Part B interactive voice response (IVR) allows providers/customers to request telephone reopenings on certain claims.

Features

• This enhancement is designed to make your requests easier and faster to process. Requests for telephone reopenings via the IVR will process the next day.

• Using this self-service feature will result in faster receipt of any applicable payments.

• The hours of availability are beyond the hours of availability for a customer service representative (CSR).

• Bonus -- The number of telephone reopening requests via the IVR are unlimited within the allotted 30-minute timeframe.

Types of reopenings available via the IVR

The following types of reopening requests are not available through a CSR; you must call the IVR for the following types of requests:

• Change date of service and quantity billed
• Change diagnosis code
• Add, delete, change modifier (except modifiers listed below)
• History corrections – including entitlement, Medicare Secondary Payer, Medicare Advantage Plan change in status or update to the patients records
• Change procedure code (can also change billed amount)
• Change quantity billed (can also change billed amount)
• Change ordering or referring provider information
Types of reopenings that cannot be performed via the IVR
• Previously adjusted claims
• Pending claims
• Non-assigned claims
• Claims for certain drug codes (listed below)

CPT®/HCPCS drug codes not allowed via the IVR
J0200	J0390	J0395	J0520	J0735	J1094	J1700
J1710	J1885	J1960	J1990	J2323	J2440	J2670
J2760	J3490	J3590	J7130	J7184	J7199	J7310
J7326	J7628	J7629	J7648	J7658	J7659	J7683
J7684	J8499	J9165	J9201	J9217	J9219	J9270
J9357	J9999	Q0144	Q2027	Q2034	Q2035	Q2036
Q2037	Q2038	Q2039	Q2045	Q2046	90654	90655
90656	90657	90658	90659	90660	90667	90668
90715	90724	90779	96549

• Request on claims containing the following modifiers, or requests to add or change these modifiers: 21, 22, 24, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, or SG, or WU.
Information you must have when calling the IVR for a reopening
• Provider’s National Provider Identifier (NPI), Tax Identification Number (TIN), and Provider Transaction Access Number (PTAN)
• Beneficiary’s last name and first Initial
• Beneficiary’s Medicare health insurance claim (HIC) number
• Beneficiary’s date of birth
• Caller’s name and 10-digit telephone number (3-digit area code and 7-digit number)
• Date of service
• Internal Control Number (ICN) -- can be obtained from your provider remit notice or the IVR when receiving a claim status
• Item(s) or service(s) at issue
• Reason for request
• New/revised information

IVR takes your request -- what’s next?
• IVR will confirm the request at the end of the call.
• If the request is approved, you will receive a letter and new remittance advice notice.
• If the request cannot be processed, a letter will be sent advising the provider of our decision.
• If the request would create an overpayment situation, the IVR will advise you to submit your request via a written redetermination form.

IVR hours of availability for telephone reopenings
• The IVR is available for requests for telephone reopenings from 7:00 a.m. to 6:30 p.m. Monday through Friday, and Saturday 7:00 a.m. to 3:00 p.m. ET.
• The toll-free Part B telephone number is 1-877-847-4992

Additional information
• No limit to the number of calls per day.
• Please have the information listed under “Information You Must Have When Calling the IVR for A Reopening” available when calling for an IVR reopening.
• Additional IVR instructions are available via our IVR Part B operating guide.