Basic (02-82)

GN 04060.005 Conditions Under Which a Determination or Decision May Be Reopened

An initial, revised, reconsidered, or reviewed determination of an intermediary, or carrier or a decision by a hearing officer, Administrative Law Judge, or Appeals Council may be reopened under the following conditions:

1. A. 

   Within 12 months after the date of the determination or decision, it may be reopened for any reason; or

2. B. 

   After such 12-month period, but within 4 years after the date of the initial determination, an initial, revised, reconsidered, or reviewed determination, or a decision of a hearing officer, may be reopened for good cause see GN 04060.025; or

3. C. 

   At any time, if (1) the determination or decision is unfavorable to the party or parties, in whole or part but only for the purpose of correcting a clerical error or an error on the face of the evidence on which such unfavorable determination or decision or unfavorable part of the determination or decision was based; or (2) the determination or decision was procured by fraud or similar fault of the party or parties, or of some other person (See GN 04060.055.)

A revised determination or decision need not be made within the above time limits as long as the reopening occurred within the time limits.