PECOS Correct and Resubmit Application Instructions

J6 Medicare Secondary Payer Overpayment Request Form

Fee-for-Service Home Health Beneficiary Notice of Noncoverage

Form CMS-339, Transmittal 8

Medicare FQHC PWK Fax/Mail Cover Sheet

Overpayment Recovery Unit FQHC Voluntary Refund Form

Medical Nutrition Therapy

Diabetes Self-Management Training

Diabetes Screening

JK Medicare Secondary Payer Part B Carrier Voluntary Refund Form

Accessing Eligibility for MDPP in NGSConnex

5010 top page

5010 277CA Reject Code Lookup ToolTo view easy-to-understand descriptions associated with the reject code(s) returned on the Status Information segment (STC) of the version 5010 277CA – Claim Acknowledgement, enter the following code [...]

5010 top page for Durable Medical Equipment

5010 277CA Reject Code Lookup ToolTo view easy-to-understand descriptions associated with the edit code(s) returned on the Status Information segment (STC) of the version 5010 277CA – Claim Acknowledgement, enter the following code information [...]

ASP Drug Form Description

ASP Drug Resources

Note: Codes that have a $0 (zero) fee schedule amount will not display a search result.Locality/Area and County Information for IllinoisLocality/AreaCounties12Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, Randolph, St. [...]

Ambulance Form Description

Ambulance Resources

Note: Codes that have a $0 (zero) fee schedule amount will not display a search result.Locality/Area and County Information for IllinoisLocality/AreaCounties12Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, Randolph, St. [...]

Ambulatory Form Description

Ambulatory Resources

Note: Codes that have a $0 (zero) fee schedule amount will not display a search result.Locality/Area and County Information for IllinoisLocality/AreaCounties12Bond, Calhoun, Clinton, Jersey, Macoupin, Madison, Monroe, Montgomery, Randolph, St. [...]