Medicare DMEPOS reopening, redetermination forms updated

February 28, 2011

The U.S. Centers for Medicare & Medicaid Services has introduced a new universal Medicare Durable Medical Equipment (DME) Reopening Request Form for all suppliers of durable medical equipments prosthetics, orthotics and supplies (DMEPOS) to use when submitting a reopening request either by mail or fax.

The new form is designed so that suppliers can easily include all of the basic information needed to submit a reopening request in any of Medicare’s four DME Medicare Administrative Contractor (MAC) Jurisdictions (Jurisdiction A—NHIC, Corp.; Jurisdiction B—National Government Services; Jurisdiction C—CIGNA Government Services; Jurisdiction D—Noridian Administrative Services).

Suppliers who submit claims in multiple jurisdictions will now need to complete only one reopening request form. Representatives from all four DME MACs collaborated to create the new form in order to ensure consistency in reopening requests across all jurisdictions. Using the new form will help to streamline the reopening submission process and will help ensure that the request is processed timely and accurately, according to the DME-MACs.

In conjunction with the new form, the four DME MACs have also developed a new Reopening Request Form Checklist and Reopening Request Form Completion Guide. Suppliers are encouraged to use these tools to determine:

  • If a claim can be reopened;
  • If a reopening is the appropriate step to take in order to resolve their initial claim determination issue(s); and
  • How to properly complete the DME MAC Reopening Request Form.

The Medicare DME Redetermination Request Form has similarly been revised to include a checkbox in which suppliers can indicate the jurisdiction to which they are submitting the request for redetermination.

To assist suppliers who submit requests for redeterminations via fax, the fax number for each jurisdiction has been added. The Medicare DME Redeter-mination Request Form Completion Guide has also been revised to include instructions regarding these changes. Like the reopening request form, the revised redetermination request form is valid in all four DME MAC Jurisdictions. The revised reopening and redetermination request forms as well as the completion guides and checklist can all be accessed at www.medicarenhic.com/dme/dme_forms.shtml#Forms.

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