How to Request a Clerical Error Reopening (CER)
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How to Request a Clerical Error Reopening (CER)
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Section 937 of the Medicare Modernization Act (MMA) required CMS to establish a process, separate from appeals, whereby providers, physicians and suppliers could correct minor errors or omissions. CMS created the Clerical Error Reopening process as a cost-effective way to correct these minor errors (which result in an initial claim denial or reduction) without using a level of appeal.
The Definition of a Clerical Error
CMS defines clerical errors as human or mechanical errors by the provider or the contractor. Such errors include:
- Mathematical or computational mistakes;
- Transposed procedure or diagnostic codes;
- Inaccurate data entry;
- Misapplication of a fee schedule;
- Computer error; or,
- Duplicate claim denials due to a clerical error or omission (e.g., a missing modifier) that the provider believes were incorrectly identified as a duplicate
- Incorrect data items, such as provider number, use of a modifier or date of service.
Corrections That Can Be Processed as a Clerical Error Reopening
- Increase number of services or units (without an increase in the billed amount)
- Add/Change/Delete modifiers such as 24, 25, 54, 57, 58, 59, 76, 78, 79, 80, 95, AS, AQ or GA (Note: Post operative modifiers 24, 25, 57, 58, 78 and 79 can be added to a paid claim so the provider can submit a procedure code without having it reduced by the unrelated visit.)
- Excluded modifiers: 22, 23, 53, 55, 62, 66, 74, and CR present on the claim, even if this is not the line being adjusted.
- Procedure Codes
- Excluded: Not Otherwise Classified codes and drug codes present on the claim, even if this is not the line being adjusted
- Place of service
- Add or change a diagnosis
- Billed amounts (without an increase in the number of unit billed)
- Change Rendering Provider National Provider Identifier (NPI)
- Date of service. The date of service change must be within the same year.
Corrections That Cannot Be Processed as a Clerical Error Reopening
The following situations cannot be corrected through the CER process. For these issues providers must submit a redetermination request in writing:
- Comprehensive Error Rate Testing (CERT) issues
- Provider Enrollment issues
- Claim denial due to no response to a development request
- Wrong payee situations
- Complex claim situations (Not Otherwise Classified codes, claims with modifiers 22, 23, 53, 55, 62, 66, 74, or CR.)
- Claims that require analysis of documentation
- Issues that require CMS input (e.g., services after date of death)
- Adding services not previously billed (This includes increasing the units AND billed amount on the same claim line.)
- Adjusting a previously adjusted claim
Situations That Cannot Be Processed as a CER or as a Redetermination
Medicare contractors can only perform a CER or an appeal if the service has an initial determination.
- If the original claim is rejected as unprocessable, submit a new claim. An unprocessable claim rejection is not an initial claim determination.
- If the claim in question is still processing, you must wait until after the claim receives an initial determination before requesting a reopening or appeal.
- If there has been no claim submitted, submit a new claim.
Time Limit for Requesting a Clerical Error Reopening
A provider, physician, or supplier may request a reopening up to one year from the receipt of the initial Remittance Notice. If the provider, physician, or supplier would like to request a reopening after the one-year time limit has expired, they may request the reopening in writing.
You must include documentation supporting good cause to waive the timeliness requirement. See the CMS Internet-Only Manual (IOM) Publication 100-04, Chapter 34 , section 10.11 for information regarding good cause.
You can use our Reopening Calculator to find the deadline for submitting a reopening request.
Methods for Submitting a Clerical Error Reopening
- WPS Government Health Administrators Portal
- Telephone
- Fax
- Postal Mail
How to Submit Your Clerical Error Reopening Request via the Portal
Providers can submit most CERs using our portal. The CER function allows providers to enter revised claim information, which the portal transmits directly to the claims processing system. The portal immediately notifies users if the claims processing system accepted the claim adjustment.
You can find more specific information on how to submit a CER in the Portal User Manual in the Clerical Error Reopenings (CER) section.
NOTE: You can only adjust claims once via the portal.
How to Submit Your Clerical Error Reopening Request via Telephone
- PTAN
- NPI
- TIN
- Claim details
How To Submit Your Clerical Error Reopening Request By Fax
To submit CER requests by fax, you must complete the Reopening Request Form and use the appropriate fax cover sheet and fax number for your state. Each fax cover sheet lists the fax number for that state.
Iowa Appeals/Clerical Error Reopening Fax Cover Sheet
Kansas Appeals/Clerical Error Reopening Fax Cover Sheet
Missouri Appeals/Clerical Error Reopening Fax Cover Sheet
Nebraska Appeals/Clerical Error Reopening Fax Cover Sheet
To submit CER requests by fax, you must complete the Reopening Request Form and use the appropriate fax cover sheet and fax number for your state. Each fax cover sheet lists the fax number for that state.
Indiana Appeals/Clerical Error Reopening Fax Cover Sheet
Michigan Appeals/Clerical Error Reopening Fax Cover Sheet
To avoid potential problems with your reopening request, make sure you fill in each field completely on the Reopening Request Form and Fax Cover Sheet form. Do not use highlight to indicate services you want us to review. We may return incomplete forms to the sender.
Please note:
- Each claim or Internal Control Number (ICN) requires a separate form. You can locate the ICN on your remittance notice.
- You must submit both the Reopening Request Form and the fax cover sheet. Submitting a fax form alone does not qualify as a valid reopening request.
- The fax confirmation generated by your fax machine provides you with confirmation that we received your request timely.
How to Submit Your Clerical Error Reopening Request by Postal Mail
global-tags: J8B,J5B,Claims,Claim Corrections
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(866) 518-3285
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Claim Status/Patient Eligibility:
(866) 234-7331
24 hours a day, 7 days a week
Claim Corrections:
(866) 580-5980
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DDE Navigation & Password Reset: (866) 580-5986
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DDE System Access: (866) 518-3295
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