New Bill Types include a Q and See New Condition Codes
Automation of the Request for Reopening Claims Process – Enhancement Request
When a provider needs to correct or supplement a claim, and the claim remains within timely filing limits, providers may submit an adjustment claim to remedy the error. 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.
Effective with claims received on or after January 1, 2015, a “new” bill type frequency code can be used by providers indicating a Request for Reopening and a series of Condition Codes can be utilized to identify the type of Reopening being requested. The NUBC adopted these new codes and bill type frequency change
1. New Type of Bill and 4th digit: These claims must be submitted with an “Q” in the 4th position of the Type of Bill (TOB xxxQ) to identify them as a Reopening.
2. New Condition Codes:
R1=Mathematical or computational mistake
R2=Inaccurate data entry
R3=Misapplication of a fee schedule
R5=Incorrectly Identified Duplicate
R6=Other Clerical Error or Minor Error or Omission (Failure to bill for services is not
considered a minor error)
R7=Correction other than Clerical Error
R8=New and material evidence is available
R9=Faulty evidence (Initial determination was based on faulty evidence)
W2=Attestation that there is no Appeal in Process