Are You Tired of Writing in to Request a Simple Claim Correction (Reopening)?


Palmetto GBA has enhanced its eServices portal to allow providers more options to reopen their claims. You can now make corrections to the following via eServices:

  • Add, remove and/or revise modifiers (see exceptions below)
  • Correct units of service
  • Update procedure codes (see exceptions below)
  • Revise or correct billed amounts

Some things to keep in mind when submitting reopenings via eServices:

  • Claims/services can only be reopened within one year from the date of the initial determination. (Some exceptions apply. If you feel you have good cause for requesting a reopening beyond the one-year time limit, please submit a written request for the correction and include evidence for good cause of late filing.)
  • Reopenings should not be requested or completed via the portal if any supporting documentation is required. (The following examples are only a sample of possible circumstances and not an inclusive listing.)
     
    • Ex: 22 Modifier – must submit documentation of extenuating services
    • Ex: 24 Modifier – must submit documentation of unrelated post-surgical services
    • “Upcoding” – must submit documentation supporting a higher-level evaluation and management service
    • Ex: 52/53 Modifiers – must submit documentation of the extent of procedure and reason for discontinuation/partial performance
    • Unlisted Procedure – must submit documentation describing the unclassified service
       
  • New charges cannot be added to your claim. You may change or update existing procedure codes or increase/decrease quantities billed, but at this time we cannot add additional lines to your claim. Please file a new claim for any additional service codes.
  • The place of service cannot be corrected via the portal. Be sure to verify your corrected procedure code is valid in the originally reported place of service. If this additional correction will also be required, please submit a written request.
  • Once you submit a reopening, no additional changes may be made. After submitting, you must wait on the reopened claim to complete processing and finalize before taking any additional action or requesting an appeal on that claim.
  • At this time, requests submitted via eServices are not being edited for accuracy or content. Your correction will be processed as submitted through the portal. If an error occurs, this may result in an outcome other than anticipated, such as a denial or rejection.
    • In the case of a rejection/invalid claim, no further reopening or appeals rights will apply. A new claim will need to be filed in order to process these charges.
    • In the case of a new or repeated denial, you may file a written appeal. (Redetermination requests must be filed within 120 days of the initial determination. Please be sure to include any supporting documentation with the appeal.)
  • Reopening a claim via eServices is not a guarantee of payment

Not currently an eServices user? It’s easy to enroll! Get started here.





Last Updated: 02/01/2021