New Part A Medicare redetermination and clerical error reopening request form available now

First Coast implemented a new and improved Part A Redetermination and Clerical Error Reopening Request Form to simplify your submission and help us better understand the intent of your appeal. We added new questions such as:  

• Does your appeal involve Medicare Secondary Payer?
• Should recoupment be stopped for a 935 overpayment?
  • If yes, we ask you to provide a copy of the overpayment letter. Not sure what a is 935 recoupment? Read MLN Matters article MM6183 for more information.
• Does your appeal involve the Recovery Auditor decision?
  • If yes, we ask you to provide a copy of the overpayment letter.
• Did the claim you’re appealing reject with message MA-130?

Additional streamlined enhancements include: 

• You no longer have to attach a revised UB-form if you’re request a clerical reopening
• You no longer have to include a copy of your remittance advice notice
• Removed the provider address field  
• Added a new field to include the procedure code(s) in question instead of asking you to describe the services being appealed 

Want to learn more? Access our tutorial  

Access our new tutorial which provides step-by-step instructions on completing our Part A Redetermination and Clerical Error Reopening Request Form to ensure more accurate processing. 

Please start using the form immediately and make sure to destroy any copies of the old form. As always, don’t forget to include any documentation to support your case along with your redetermination request.