MLN Connects® for Thursday, January 7, 2021

MLN Connects® for Thursday, January 7, 2021 COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit View this edition as a: Webpage | PDF News COVID-19 Vaccines: CDC Long-Term Care Facility Toolkit MLN Web-Based Training: Complete [...]

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

Prior Authorization Request for Outpatient Services: Panniculectomy

Prior Authorization Requests Submitted by Exempt Providers Alert The National Government Services PA Department has observed an increase in submission of PAR for exempt providers. These submissions are from the HOPD and/or physician offices on [...]

Hospice Cap

Medicare Number

Chapter I: Online System Terminology Medicare Number Purpose The FISS DDE Provider Online System utilizes the terminology MBI to identify the beneficiary’s Medicare number. For the purpose of this manual, “Medicare [...]

Program Function Keys

Chapter III: Navigating the Online System Program Function Keys Purpose The following chart outlines the screen movement associated with each of the keyboard program function <F/PF> keys. Note: From a functional standpoint, [...]

Appeals Calculator Levels of Appeal Table

Five Levels of Appeals: Overview Levels Level One Level Two Level Three Level Four Level Five Type of Appeal Redetermination Reconsideration (QIC) Administrative Law Judge (ALJ) Medicare Appeals [...]

About the 201 Pend Report

Chapter VII: Online Reports View Submenu (04) About the 201 Pend Report Purpose The 201 Pend Report is designed to assist providers in accessing information regarding the status of their submitted claims. This report is available to view [...]

About the 702 ACS Appeals Received Report

Chapter VII: Online Reports View Submenu (04) About the 702 ACS Appeals Received Report Description: The Automated Correspondence System (ACS) master record inputs into the system so that this daily report can be created to allow providers [...]

Request a Redetermination

Request a Redetermination The first level of appeal is the redetermination and is carried out by the MAC. Time limit to initiate = 120 days from date of receipt of the initial determination notice Time limit to complete the [...]

About NGSConnex

This user guide is specific to your line of business and state. To ensure you are viewing the correct user guide, check your information in the top right corner. If your line of business and state is not correct, please select your applicable [...]

Email Verification

Email Verification The Email Verification screen will display the first time you log in to NGSConnex. All NGSConnex users are required to complete a one-time verification to validate the email associated with their NGSConnex user profile. The [...]

Printing in NGSConnex

Printing in NGSConnex You have the ability to print in several areas of NGSConnex. The printable information will display in a separate window. Select the Printable View icon or link. Right-click your mouse to view and print or save [...]

View Remittance

View Remittance If you receive SPR you will not be able to view remittance statements in NGSConnex. If you are signed up to receive an 835 ERA or have elected to view remittance statements through NGSConnex, you may view and print remittance [...]

Annual Security Training

Annual Security Training Every 365 days, NGSConnex LSOs and users are required to review the annual Security Awareness Training, including the rules of behavior and acknowledge access still is required, NGSConnex will display the Security [...]

Forgot User ID or Password

Account Suspension

Ophthalmology/ Optometry

Laboratory/ Pathology

About the 050 Claims Returned to Provider

Chapter VII: Online Reports View Submenu (04) About the 050 Claims Returned to Provider Description This is a listing by provider of claims in RTP status. The claims on the report are in status/location TB9997. The daily report will be [...]

Key Features

Key Features PC-ACE is a comprehensive claims management system. Some of the more prominent features include: Combined Medicare Part A, Institutional All-Payer and Professional claims system Electronic submission of claims in ANSI-837 [...]

Minimum System Requirements and Support

Minimum System Requirements and Support Minimum System Requirements SVGA monitor resolution (800 x 600) Windows 10, Windows 8.1, Windows 7 or Vista operating system Adobe Acrobat Reader Version 4.0 or later (for overlaid claim [...]

Minimum System Requirements and Support

Minimum System Requirements and Support In order to use this application you must have NET framework (at least 2.0 service pack 2) installed on each PC utilizing this application. Requires WinZip or compatible decompression application to [...]

Key Features

Key Features MREP software offers the following capabilities: MREP provides for the ability to view and print the following as needed: List of all Claims for a Remittance Details for a single Claim Total Amounts for a Remittance Look up [...]

Technical Guides and Information

Technical Guides and Information 5010 Process Flow Chart X12 Website: Technical Reports/Implementation Guides, Newsletters and X12 Transaction Sets

What is NGSConnex?

What is NGSConnex? NGSConnex  is a free, secure, web-based application developed by National Government Services just for you! NGSConnex provides access to a wide array of self-service functions that save you time and money, such as: [...]

Handwriting on Claims Submitted to Medicare

Handwriting on Claims Submitted to Medicare National Government Services will return to the provider any paper claim submitted with handwriting on the face of the claim that is not a signature field, (i.e., Items 12, 13 or 31). A notice will [...]