Medicare Claims Processing Manual (Pub. 100-04), Ch. 34 § 10.2
Refusal to Reopen Is Not an Initial Determination
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.