Reopenings and Redeterminations

A reopening is a reprocessing of a claim to fix minor mistakes.

• True

• False

You will have as long as you want to submit a Redetermination.

• True

• False, you have 120 days from the claim determination.

A redetermination is an examination of a claim that includes analysis of documentation.

• True

• False

Modifiers 24, 25, 57, 58, 59, and 78 are some examples of Reopenings.

• True

• False

Modifiers 22, 52, 53 require claim documentation to avoid having to submit a redetermination.

• True

• False

When Medicare records are updated to show as primary payer, providers cannot reopen via Connex.

• True

• False

Are changing diagnosis codes redeterminations?

• Yes

• No

Would you reopen a claim to void line billed in error and resubmit a corrected claim?

• No, correct the initial claim.

• Yes

Are Modifiers GV and GW reopenings or redetermination

• Reopenings

• Redeterminations

When submitting a redetermination for repeat procedures, will you need to supply documentation on how many services were performed?

• Yes

• No