CMS CR 7080 - Timely Claims Filing: Additional Instructions.CMS Change Request (CR) 6960 - Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months.If the change or addition affects a line item instead of a claim item, please indicate which lines are being changed in the remark/note. To assist in quickly processing a reopening, any reopening request that contains changes or additions from the original claim should contain a remark/note explaining what has been changed.GOOD CAUSE- F-E (FAULTY EVIDENCE) BECAUSE….GOOD CAUSE- NME (NEW AND MATERIAL EVIDENCE) BECAUSE….GOOD CAUSE- C-A PSC (CHANGED OR ADDED PATIENT STATUS CODE) BECAUSE….GOOD CAUSE- C-A LIDOS (CHANGED OR ADDED LINE ITEM DATES OF SERVICE) BECAUSE….GOOD CAUSE- C-A PX (CHANGED OR ADDED PROCEDURE CODE) BECAUSE….GOOD CAUSE- C-A MOD (CHANGED OR ADDED MODIFIER) BECAUSE….GOOD CAUSE- C-A DX (CHANGED OR ADDED DIAGNOSIS CODE) BECAUSE….GOOD CAUSE- C-A VC (CHANGED OR ADDED VALUE CODE) BECAUSE….GOOD CAUSE- C-A OSC (CHANGED OR ADDED OCCURRENCE SPAN CODE) BECAUSE….GOOD CAUSE- C-A OC (CHANGED OR ADDED OCCURRENCE CODE) BECAUSE….GOOD CAUSE- C-A CC (CHANGED OR ADDED CONDITION CODE) BECAUSE….The first fifteen (15) characters of the remark/note must match exactly as shown below. If the change or addition affects a line item (shown as bold) instead of a claim item, please indicate which lines are being changed in the remark/note. Remarks/notes should be formatted as shown below without the parenthetical explanation (this is not an exhaustive list) and a narrative explanation after the word “because”. Reopenings that require “Good Cause” to be documented must have a Remark/Note from the provider.R1 = 4 yr Initial Determination (from Remittance Advice date).(For DDE claims only) An “Adjustment Reason Code” from the reopening subset below on claim page 3 (MAP1713). A provider cannot reopen a bill and appeal the same bill simultaneously. When a provider uses this code they are attesting that they are reopening a bill already sent to the Medicare program and that there is no Appeal in Process. A Condition Code W2=Duplicate of an original bill.D9 = Change in Condition Codes, Occurrence Codes, Occurrence Span Codes, Provider ID, Modifiers and other changes.D4 = Change in Clinical Codes (ICD) for Diagnosis and/or Procedure codes.D2 = Changes in Revenue Code/HCPCS/HIPPS Rate Codes.A Condition Code to identify what was changed (if appropriate):.R9 = Faulty evidence (Initial determination was based on faulty evidence).R8 = New and material evidence is available.R7 = Correction other than Clerical Error.R6 = Other Clerical Error or Minor Error or Omission (Failure to bill for services is not consider a considered a minor error.R1 = Mathematical or computational mistake.Providers must submit appeal requests for such denials. Providers are reminded that submission of adjustment bills (TOB xxx7) or reopening requests (TOB xxxQ) in response to claim denials resulting from review of medical records (including failure to submit medical records in response to a request for records) is not appropriate. The reopening request (TOB xxxQ) should only be utilized when the submission falls outside of the period to submit an adjustment bill. When the need for a correction is discovered beyond the claims timely filing limit, an adjustment bill is not allowed and a provider must utilize the reopening process to remedy the error. Reopening Claims Beyond Claim Filing Timeframes
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