Second Level Appeal Request:
Reopening If the reopening request is the result of medical review decision (N102 on your Remittance Advice-RA), please attach a copy of the RA and any supporting documentation. If you are unsure whether to request a redetermination or a reopening, request a redetermination as there are specific time limits for submitting redetermination requests.
You can request a Reopening from Palmetto GBA to reopen the claim and correct the following minor errors or omissions:
= Mathematical or computational mistakes 4 If you submitted the incorrect units (i.e., 1 instead of 2 in item 24G or its electronic equivalent), adjust the charge accordingly
= Transposed procedure or diagnostic codes
= Inaccurate data entry = Misapplication of a fee schedule
= Computer errors
= Duplicate denials – When you believe that the ‘duplicate’ denial is incorrect (e.g., ambulance trip denied as duplicate, but there were two identical trips on the same day)
= Incorrect data items such as a modifier or date of service (month and day only)
= Adjustments to claims that were submitted in error that will result in an overpayment. Palmetto GBA will initiate the overpayment process when you notify us that this situation has occurred.
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