Timeframes to Complete a Reopening Requested by a Party

10.7 - Timeframes to Complete a Reopening Requested by a Party (Rev. 2241; Issued: 06-17-11, Effective: 10-01-11, Implementation: 10-03-11) There are no timeframes established in statute or regulation governing the timeframes for a contractor to complete a reopening action. However, a party to an initial determination has a reasonable expectation to the administrative finality of a determination issued by Medicare. Therefore, this section sets out timeframes to complete the reopening action once the reopening has been initiated. These timeframes apply only to those reopening requests that are requested by the party to the initial determination. These timeframes do not apply to contractor initiated reopenings. For those reopenings requested by a party that the contractor agrees to reopen, the contractor shall complete the reopening action 60 days from the date of receipt of the party’s reopening request in the corporate mailroom, receipt in a secure Internet portal/application, or receipt of the telephone request. This does not apply to “big box cases” defined as aggregated requests filed by a provider, physician, or other supplier that involve 40 or more beneficiaries/claims and $40,000 or more in controversy.