Medicare Claims Processing Manual (Pub. 100-04), Ch. 34 § 10.2

Refusal to Reopen Is Not an Initial Determination

Last amended: 2006Year: 2006Length: 115 wordsOfficial source
10.2 - Refusal to Reopen Is Not an Initial Determination (Rev. 1069, Issued: 09-29-06, Effective: 11-29-06, Implementation: 11-29-06) A finding that a prior determination or decision will not be reopened is not an “initial determination or decision.” A contractor’s choice not to reopen is not appealable. Accordingly, the contractor shall not include a statement concerning the right to an appeal in the notice informing the party that their reopening request cannot be processed. A party may however request an appeal on the original claim denial, but must do so within the required timeframes. If a contractor receives a reopening request and does not believe they can change the determination, they should not process the request.
Medicare Claims Processing Manual (Pub. 100-04), Ch. 34 § 10.2: Refusal to Reopen Is Not an Initial Determination | Justis AI