How to Adjust a Claim

Resources How to Adjust a Claim To adjust a claim using the FISS/DDE Provider Online System, follow these steps: Step Action 1 Select the CLAIMS CORRECTION (03) submenu from the MAIN MENU 2 Key the [...]

FISS Claim Change/Condition Reason Codes

Resources FISS Claim Change/Condition Reason Codes The following adjustment/cancel claim change reason codes may be reported in the COND CODE field on CLAIM PAGE 01 of the adjustment/cancel claim record. For Adjustment Claims Only (TOB [...]

How to Cancel a Claim

Resources How to Cancel a Claim To cancel a claim on the FISS/DDE Provider Online System, follow these steps: Step Action 1 Select the CLAIMS CORRECTION (03) submenu from the MAIN MENU 2 Key the [...]

Online System Menu Quick-Reference

Resources Online System Menu Quick-Reference Main Menu Inquires Submenu (01) Claims/Attachments Submenu (02) 01 – Inquires 02 – Claims/Attachments 03 – Claims Correction 04 – Online Reports View 10 [...]

Document Control Number

Chapter I: Online System Terminology Document Control Number Purpose The FISS DDE Provider Online System refers to the claim control number as a DCN. The DCN provides a reference number for the control and monitoring of each claim. To [...]

LCD, Billing and Coding Article Updates for August 2023

LCD, Billing and Coding Article Updates for August 2023 New LCDs and Articles (Effective 8/1/2023) Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin [...]

End-Stage Renal Disease

NGSMedicare Videos

Home Health Aide Services and the Intermittent or Part-Time Rule

Home Health Aide Services and the Intermittent or  Part-Time Rule Job Aid The CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Section 50.2 states: The reason for the visits by the home health aide must [...]

PDGM Resources

PDGM Resources MLN Matters Article MM11081 – "Home Health Patient-Driven Groupings Model (PDGM) - Split Implementation" MLN Matters Article MM11395 – "Home Health Patient-Driven Groupings Model - Revised and Additional Manual Instructions" [...]

Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment

Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment This edit is applied to claims when a RAP and final episode claim are submitted at the same time or when a RAP is submitted when there is one for the same [...]

ESRD PC Pricer

Long-Term Care Hospital PPS PC Pricer

Inpatient Psychiatric Facility PPS PC Pricer

Inpatient Rehabilitation Facility PPS PC Pricer

How to Become a Medicare Enrolled OTP Supplier

How to Become a Medicare Enrolled OTP Supplier OTPs with current, valid, and full certification by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by a SAMHSA-approved accrediting body; including DEA and [...]

Prior Authorization Request for Outpatient Services: Botulinum Toxin

Prior Authorization Request for Outpatient Services: Blepharoplasty, Blepharoptosis Repair and Brow Ptosis Repair

Prior Authorization Request for Outpatient Services: Vein Ablation

Prior Authorization Request for Outpatient Services: Rhinoplasty