Reopening requests must be submitted within one-hundred eighty (180) calendar days of the reconsideration. Reopened appeals must have “good cause”.
Good cause is defined by:
New and material evidence with justification for not including said evidence with the initial request for reconsideration
Error on the face of the evidence on which such determination or decision is based
Clerical error in the claim file
The QIC will issue a new reconsideration decision within (120) calendar days of request and notify the appealing parties.
Note: If the case has already been submitted to the Office of Medicare Hearings and Appeals (OMHA) for an Administrative Law Judge (ALJ) hearing, the QIC (in this case RiverTrust) has no jurisdiction and cannot reopen the appeal.
