National Government Services: Raising Awareness about Care Management

National Government Services: Raising Awareness about Care Management According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your Medicare Contractor for Jurisdiction 6 and [...]

You Can Help Your Patients Quit Tobacco Use - The Great American Smokeout Is Coming!

You Can Help Your Patients Quit Tobacco Use - The Great American Smokeout Is Coming! Join us for our webinar series on Medicare’s preventative services, "Counseling to Prevent Tobacco Use" and “Telehealth and Tobacco Counseling.” Statistics [...]

FY 2026 PUF Release

FY 2026 PUF Release Availability and Revisions to Wage Index PUF On Thursday, 5/23/2024, CMS released the preliminary FY 2026 Worksheet S-3, Parts II and III wage index PUF. The FY 2026 IPPS wage index will be calculated based on Federal FY [...]

National Government Services Proposed LCDs for Comment

National Government Services Proposed LCDs for Comment The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 5/30/2024 through 7/14/2024. These [...]

June 2024

In This Issue National Government Services Articles for Part A and Part B Providers Important Reminders for Your EDI Enrollment Save the Dates! CMS National Provider Enrollment Conference in San Diego: 8/28/2024-8/29/2024 A/B DME MAC [...]

Attention Illinois, Massachusetts and Rhode Island Providers: Senior Medicare Patrol Can Assist Medicare Providers!

Attention Illinois, Massachusetts and Rhode Island Providers: Senior Medicare Patrol Can Assist Medicare Providers! National Government Services is proud to announce a special project to assist our providers with your Medicare patients [...]

Attention Illinois, Massachusetts and Rhode Island Providers: Senior Medicare Patrol Can Assist Medicare Providers!

Supplemental Insurance

Section 2: Medicare Basics Supplemental Insurance Table of Contents Supplemental Insurance Medigap Plans Medigap Plans A–N Low-Income Beneficiaries Qualified Medicare Beneficiary Program Specified Low-Income Medicare [...]

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 11th Sessions!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 11th Sessions! We’re gearing up for our second in the series of Medicare Part B 2024 Spring/Summer Virtual [...]

SNF PPS Web Pricer

MLN Connects® Newsletter: June 6, 2024

MLN Connects® Newsletter: June 6, 2024 News CMS Roundup (May 31, 2024) Quality Payment Program: 2022 Performance Information on Medicare.gov Compare Tool Skilled Nursing Facility Value-Based Purchasing Program: June Confidential Feedback [...]

EDI Enrollment Process User Guide

This guide provides information on the different options available within the National Government Services EDI Enrollment Process User Guide. Please share your thoughts about your experience with our EDI Enrollment process.   Reviewed 6/6/2024

EDI Enrollment

Welcome This page is for providers who wish to submit Part A/B claims to Medicare. Once you have completed the initial provider enrollment and received your Welcome letter with Medicare, you can begin the EDI Enrollment process. Table of [...]

Benefits of EDI and Real Time Claim Status

There are a number of advantages to enrolling and submitting claims online. Claims and other transactions submitted electronically process considerably faster than paper submission. For example, HIPAA-compliant electronic claims are held in the [...]

Reset My FISS / DDE Password

CMS has directed it’s datacenters to enforce password requirements set forth in the United States Defense Information Systems Agency’s (DISA) Security Technical Implementation Guide (STIG) with regard to RACF password quality rules. The HPE VDC [...]

I Am Not Yet Enrolled in Medicare

You can only begin set up with EDI if you are a participating provider in the Medicare program. If you have not submitted an application to enroll in Medicare, please visit our Enrollment section of the site for guidelines. If you have a [...]

Trading Partner ID Recertification

All active trading partners are required to recertify their access annually. CMS requires any changes in demographic, contact information or access for a trading partner ID (TP ID) are communicated to the A/B MAC within 30 days of the change. [...]

National Government Services Contractor Codes

National Government Services Contractor Codes The Contractor Code is a five-digit numeric code that indicates your MAC, also known as the Carrier Code, or Payer ID. Part B Professional: Connecticut 13102 Illinois 06102 Maine 14112 [...]

Supporting Documentation Information

Supporting Documentation Information

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers on Tuesday, June 4th

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers on Tuesday, June 4th! Our first in our series of Medicare Part B 2024 Spring/Summer Virtual Conference Tuesdays is right around [...]

Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines

Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines Medicare covers influenza virus, pneumococcal and hepatitis B vaccines in accordance with coverage requirements, when furnished by a hospice to those [...]

Home Health Claims Returned to Providers with Reason Code 31755

CMS reactivated RC 31755 effective 1/3/2023 and some HH claims are being RTP due to billing errors. These claims need to be corrected with the information provided in the Provider Action section of this article. Medicare is still receiving [...]

MLN Connects® Newsletter: June 13, 2024

MLN Connects® Newsletter: June 13, 2024 News Medicare Shared Savings Program: Apply for January 1 Start Date by June 17 Men’s Health: Encourage Your Patients to Prioritize Their Health Compliance Hospital Beds & Accessories: [...]

Paper Enrollment Process

Paper Enrollment Process Enrollment via paper is an option, but PECOS is the preferred method to process the application with streamlining features. Paper-based enrollment applications are available. Determine which CMS Paper Form you will [...]

Complete All Topics

Complete All Topics Instructions for completing all PECOS topics: Select the ‘Topic View’ tab and add information in every topic Note: The electronic funds transfer (EFT) topic must be completed by: groups suppliers sole owner group [...]

Upload Supporting Documents

Upload Supporting Documents Instructions for PECOS to upload required supporting documentation: Select the ‘Topic View’ tab Select “Required and/or Supporting Documents” Upload documents Mandatory for all provider/supplier types: [...]

Resolve All Errors and Verify Warnings

Resolve all Errors and Verify Warnings Instructions for resolving all errors and warnings: Select the ‘Errors/Warning Check’ Tab.   Correct all errors identified and verify any warnings.   Related Content Resolving PECOS [...]

Verify and Manage Signature(s)

Verify and Manage Signature(s) Verify signatures on all application(s) submitted including applications that were “Return for Corrections”, by returning to the enrollment box in PECOS. Important: The reassignments are viewed by selecting [...]

Determine your Business Structure

Determine your Business Structure When starting a business, you must decide what form of business entity you wish to establish. The legal structure you choose for your business has more to do with tax, liability and management arrangements. [...]

Individual (Group Member) Reassigning Benefits Only

Individual (Group Member) Reassigning Benefits Only Download CMS-855I: Complete sections 1, 2, 3, 4, 4F, 12, 13 and 15 (B and C). Reassignment means that an individual physician, nonphysician practitioner, or other supplier has granted [...]

Ordering/Referring Provider Only

Ordering/Referring Provider Only Download CMS-855O. Complete sections 1, 2, 3, 4, 5, 6 and 8. Note: Ordering and referring providers are only required to be enrolled in one state. Be sure to include supporting documentation for [...]

Adding a New Reassignment of Benefits Using the CMS-855I

Adding a New Reassignment of Benefits Using the CMS-855I Download CMS-855I version (5/23): Complete sections 1A and B, 2A, 3, 4F (add, terminate, change reassignment), 13, and 15B and 15C IMPORTANT: If an individual is new to the [...]

Electronic Funds Transfer Agreement

Electronic Funds Transfer Agreement Download and complete the CMS-588 EFT Authorization Agreement. Physicians and nonphysician practitioners who are reassigning all of their payments to another entity are not required to submit the CMS-588. [...]

Medicare Participating Physician or Supplier Agreement

Medicare Participating Physician or Supplier Agreement Download and complete CMS-460 Medicare Participating Physician or Supplier Agreement. Note: CMS-460 must have a signature and date of participant or authorized representative of [...]

1-800-MEDICARE Authorization to Disclose Personal Health Information

Medicare Correspondence Request Form

Prior Authorization Request for Outpatient Services: Implanted Spinal Neurostimulators

Hospice Visit Reporting

Hospice Visit Reporting Table of Contents Background Discipline Visits Reporting Visits in the Routine Home Care, Continuous Home Care and Inpatient Respite Care Levels of Care Discipline Revenue and HCPCS Coding Required Detail for [...]

How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period

How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period Background CMS requires that a hospice physician or hospice nurse practitioner must have a FTF encounter with each hospice patient prior to the beginning of the [...]

Prior Authorization HCPCS Tool Top

Prior Authorization HCPCS Code Inquiry Tool This is a self-service tool to allow ambulance service providers, hospital, or physician office staff responsible for submitting prior authorization requests (PARs), to determine if the procedure [...]

Prior Authorization Request for Outpatient Services: Cervical Fusion

Creating application in PECOS

Creating Application in PECOS Instructions to create an application in PECOS: Login to PECOS My Associates Create Initial Enrollment Application Note: There will be a series of questions to determine application descriptions tailored to [...]

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 18th Sessions!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 18th Sessions! Our third in the series of Medicare Part B 2024 Spring/Summer Virtual Conference Tuesday’s [...]

Eligible Physicians

Eligible Physicians Physicians who can enroll in Medicare: Doctor of: Medicine (MD) Osteopathy (DO) Chiropractic (DC) Dentistry (DMD) (DDS) Optometry (OD) Psychiatry (MD) Podiatry (DPM) Reviewed 6/13/2024

Eligible Nonphysicians

Eligible Nonphysicians Nonphysician Practitioners who can enroll in Medicare. Below you can find the definition, qualifications and supporting documentation for each specialty. Visit Obtain/Verify State License for assistance with license [...]

Eligible Part B Suppliers

Eligible Part B Suppliers Suppliers who can enroll in Medicare: Ambulance Service Supplier Ambulatory Surgical Centers (ASC) Clinic/Group Practices Hospital Department(s) Home Infusion Therapy (HIT) Independent Clinical Laboratory [...]

State License and Registrations for Individuals and Organizations

State License and Registrations for Individuals and Organizations Prior to submitting a provider enrollment application to Medicare, ensure that all applicable state licensing and/or specialty certification requirements are current. Each state [...]

How to Submit a Hardship Request

How to Submit a Hardship Request To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be [...]

How to Obtain a Refund

How to Obtain a Refund A refund will only be granted in the following instances: The application fee was not required for the application submitted A hardship request was subsequently approved and a fee was paid An application was [...]

Electronic Funds Transfer

Electronic Funds Transfer EFT allows for claim payments to be electronically transferred to your bank in place of a hard copy check mailed to the facility. Medicare payments due a provider or supplier of services may be sent to a bank (or [...]

Electronic Funds Transfer Form and Instructions

Electronic Funds Transfer Form and Instructions To initiate the EFT process, you will need to complete the Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588). By signing the CMS-588 form, you are certifying the account is in [...]

Verify Bank Account Information

Verify Bank Account Information National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. To prevent interruption in Medicare payment, billing providers verify [...]

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: CustomerService-DoNotReply@cms.hhs.gov containing the PECOS web tracking number. [...]

Requests for Additional information

Requests for Additional information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]