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