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Posting Date: 02/22/2023
Chimeric Antigen Receptor (CAR) T-cell Therapy
Chimeric Antigen Receptor (CAR) T-cell Therapy Table of Contents NCD 110.24: Chimeric Antigen Receptor (CAR) T-cell therapy: Billing Instructions Overview Billing and coding CAR T-cell therapy for inpatient services Clinical [...]
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Posting Date: 09/19/2024
MLN Connects® Newsletter: September 19, 2024
MLN Connects® Newsletter: September 19, 2024 News Resources & Flexibilities to Assist with the Public Health Emergency in Louisiana Skilled Nursing Facilities: Report Your Expanded Ownership, Management, & Related Party Data [...]
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Posting Date: 09/19/2024
Billing Errors on 2024/2025 Influenza Season Claims
Billing Errors on 2024/2025 Influenza Season Claims The influenza season runs from August 1st of each year until July 31st the following year. Every influenza vaccine is assigned a new NDC each season. This season, some codes no longer have a [...]
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Posting Date: 01/19/2022
Learn About MDPP
Learn About MDPP The MDPP expanded model includes an evidence-based set of services aimed to help prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. MDPP services is available to eligible [...]
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Posting Date: 01/19/2022
Framework for Prevention and Goals
Framework for Prevention and Goals CMS along with the CDC provides a framework for diabetes prevention efforts. It brings together partners from the public and private sectors to prevent or delay type 2 diabetes. The MDPP is structured [...]
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Posting Date: 01/19/2022
Delivering a Lifestyle Change for Medicare Beneficiaries
Delivering a Lifestyle Change for Medicare Beneficiaries Providers play a vital role in beneficiary referrals. Although a referral is not required, a provider’s assessment during the AWV or the IPPE is strongly recommended by NGS. Providers [...]
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Posting Date: 01/19/2022
Receiving CDC Recognition and Medicare Enrollment
Receiving CDC Recognition and Medicare Enrollment Organizations who wish to furnish MDPP services to beneficiaries and bill Medicare for those services must enroll in Medicare as an MDPP supplier. To become a Medicare-enrolled MDPP supplier, [...]
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Posting Date: 01/19/2022
MDPP Codes and Payment Amounts 2023
MDPP Codes and Payment Amounts 2023 HCPCS G-codes are used when submitting claims to bill Medicare for payment. MDPP HCPCS G-codes may be used only one time per eligible beneficiary (except for G9890 and G9891). The initial session (G9873) [...]
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Posting Date: 02/06/2024
MDPP Codes and Payment Amounts 2024
MDPP Codes and Payment Amounts 2024 Medicare pays up to 22 visits billed with codes G9886 and G9887, combined, in a 12-month period: Months 1–6: one in-person/distance learning visit every week (up to 16) Months 7–12: one [...]
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Posting Date: 01/19/2022
MDPP Billing Information
MDPP Billing Information In addition to the usual information that needs to be completed to file a claim for a Medicare Part B service to your MAC, you will need to complete the following items of the CMS-1500 form or electronic equivalent [...]
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Posting Date: 01/19/2022
Contact Information and Resources
Contact Information and Resources Inquiry Type Examples Help Desk Contact Information Process of MDPP CDC Recognition Credential via CDC, check status of application for CDC recognition or submitting [...]
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Posting Date: 11/15/2021
Prevent Revalidation Processing Delays
Prevent Revalidation Processing Delays When National Government Services receives a revalidation application, we often determine additional information is needed to process the application. In those cases, a request for additional information [...]
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Posting Date: 08/01/2024
Medicare University
Medicare University National Government Services offers a variety of teleconferences, webinars and face-to-face educational sessions on Medicare-related topics including rules and regulations throughout the year. Medicare University (MU), our [...]
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Posting Date: 09/10/2024
Expected Timeframes for Therapy Services
Expected Timeframes for Therapy Services CMS and CPT guidelines for provider time spent and documented on therapy services may vary, depending on the definition of the service and the context in which it is performed. Therapy services [...]
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Posting Date: 01/29/2020
EDI and How it Works
EDI and How it Works EDI is an electronic communication method that enables fast, accurate and reliable exchange of data between the computer systems of organizations that do business together by using the same standardized message formatting, [...]
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Posting Date: 09/23/2024
Benefits of EDI and Real Time Claim Status
Table of Contents Benefits of EDI and Real Time Claim Status Real Time Claim Status and Response - A Faster Better Option [Return to Top] Benefits of EDI and Real Time Claim Status There are a number of advantages to enrolling and [...]
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Posting Date: 01/29/2020
Benefits of Electronic Attachments
Benefits of Electronic Attachments The X12 275 Attachment transaction supports sending additional documentation electronically. Clinical documentation includes but not limited to; operative notes, consult notes, procedure notes, care plan, and [...]
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Posting Date: 08/13/2020
How to Get Started - Five Easy Steps
How To Get Started – Five Easy Steps Contact your vendor, clearinghouse or billing service to ensure they support the electronic attachment program which includes the following: 6020 version of the 275 transaction; HL7 CDA R2 [...]
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Posting Date: 07/09/2020
Participating Clearinghouses and Vendors
Participating Clearinghouses and Vendors The following entities support electronic attachments with NGS. Any of these entities can assist you with implementing electronic attachments and participating in the NGS Attachment Program. [...]
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Posting Date: 08/10/2023
Duplicate Claim Editing Information
Duplicate Claim Editing Information National Government Services implemented a Part A duplicate claim edit in our EDI front-end processing system. Providers are notified that a claim is a duplicate upon receipt of the 277 Claims [...]
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Posting Date: 03/01/2022
Benefits of Electronic Remittance Advice
Benefits of Electronic Remittance Advice Table of Contents Benefits of Electronic Remittance Advice There Are Several Benefits to Choosing ERA Versus SPR Help Interpreting the ERA Is Available [Return to Top] Benefits of Electronic [...]
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Posting Date: 02/17/2022
How to Get Started
How to Get Started Making the change is easy. If you use a clearinghouse to submit claims, contact your clearinghouse to ask how to enroll for the electronic remittance service. If you currently have a claim submission software program, [...]
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Posting Date: 01/29/2020
Benefits of the 277 RFI
Benefits of the 277 RFI The X12 277 RFI transaction replaces the paper Additional Development Request letters. The 277RFI transaction is available for JK/J6 Part A and Part B providers. The benefits of the 277RFI transaction include: [...]
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Posting Date: 04/20/2020
Participating Clearinghouses and Vendors
Participating Clearinghouses and Vendors The following entities support electronic attachments with NGS. Any of these entities can assist you with implementing electronic attachments and participating in the NGS Attachment Program. [...]
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Posting Date: 06/22/2022
Standard Companion Guide Trading Partner Information
Standard Companion Guide Trading Partner Information Instructions Related to the X12 277 Health Care Claim Request for Additional Information Version 6020 Companion Guide Version Number: 6.0 Revised: October 2019 Preface Companion Guides [...]
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Posting Date: 04/20/2022
Standard Companion Guide Trading Partner Information
Standard Companion Guide Trading Partner Information Instructions Related to the X12 278 and 275 Prior Authorization Transactions Companion Guide Version Number: 1.0 Created: April, 2022 Preface Companion Guides (CG) may contain two types of [...]
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Posting Date: 03/08/2021
Related Content
Related Content WPC Health Care Code Lists Health Care Payment and Remittance Advice: Provides information on ERA and companion documents for assistance with receiving the Transaction 835. CMS IOM Publication, Medicare Claims Processing [...]
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Posting Date: 09/28/2022
EDI Gateway Self-Service Password Portal Overview
EDI Gateway Self-Service Password Portal Overview Table of Contents EDI Gateway Self-Service Password Portal Overview Changing versus Resetting Your Password Changing Your Password Resetting Your Password EDI Gateway Self-Service [...]
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Posting Date: 09/19/2022
Changing Your EDI Password
Changing Your EDI Password EDI passwords have to be regularly changed or reset to maintain data security. You should note that passwords expire every 60 days and can be changed or reset prior to expiration. Follow these steps to change your [...]
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Posting Date: 09/19/2022
Resetting Your EDI Password
Resetting Your EDI Password EDI passwords have to be regularly changed or reset to maintain data security. You should note that passwords expire every 60 days and can be changed or reset prior to expiration. Follow these steps to reset your [...]
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Posting Date: 09/19/2022
Password Reset Requirements Checklist
Password Reset Requirements Checklist The following information will assist you in successfully resetting your password and eliminate any unnecessary disconnects. You should note that passwords expire every 60 days and can be reset prior to [...]
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Posting Date: 09/19/2022
Setting Your Security Questions
Setting Your Security Questions Setting up Security Questions is part of the required process for establishing an EDI Gateway Self-Service Portal account. Follow these steps to set up your account Security Questions. Access the Trading [...]
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Posting Date: 01/29/2020
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 [...]
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Posting Date: 01/29/2020
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 printing) [...]
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Posting Date: 06/15/2022
Creating a 276 Claim Status Request in PC-ACE
Creating a 276 Claim Status Request in PC-ACE Claim Status Request Files must be prepared and transmitted using communication software. Select INST or PROF from the PC-ACE Claims Processing System main menu. Select List Claims [...]
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Posting Date: 12/19/2016
PC-ACE for Institutional Users: Importing and Reading the 999 and 277CA Files
PC-ACE: Importing and Reading the 999 and 277CA Files In order for PC-ACE to read 999 or 277CA files, they must be saved into the proper sub-folder within the WINPCACE folder. 277CA files go within the Stat1500 (Part B) sub-folder or the [...]
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Posting Date: 03/28/2022
PC-ACE Quick Reference Guide: Medicare Secondary Payer
PC-ACE Quick Reference Guide: Medicare Secondary Payer The following are Medicare A (Institutional) instructions for entering line item and claim information into PC-ACE when Medicare is the secondary payer. Situations where Medicare is the [...]
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Posting Date: 11/19/2018
View and Print ERA in PC-ACE
View and Print ERA in PC-ACE PC-ACE offers the ability to translate an ERA to either view and/or print for both institutional and professional ERAs after they have been downloaded. ERAs viewed/printed in PC-ACE provides the same data that is [...]
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Posting Date: 11/17/2020
Download PC-ACE
Download PC-ACE Download PC-ACE If you intend to administer the COVID-19 vaccines when they become available, or the new monoclonal antibody bamlanivimab, especially if you intend to roster bill these codes, please download and install the [...]
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Posting Date: 01/29/2020
About PC Print
About PC Print The PC Print software is available for providers to view and print HIPAA-compliant ERAs from their own computer. The PC Print software is available to you at no cost. This software is easy to use and will save you both time and [...]
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Posting Date: 01/29/2020
Key Features
Key Features PC Print offers several different report displays and the ability to print the reports as needed. The Single Claim Report includes the activity at the claim and detail line items for a single claim. The All Claims Report [...]
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Posting Date: 01/29/2020
Minimum System Requirements and Support
Minimum System Requirements and Support PC Print is only compatible with officially supported Microsoft Windows Operating Systems. Please note that PC Print v4.2.6 is the only version compatible with Windows XP. PC Print software allows [...]
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Posting Date: 06/03/2022
Network Service Vendors
Network Service Vendors National Government Services requires connectivity to the EDI Gateway for exchange of EDI data through select NSVs. In addition to connectivity to the EDI Gateway for the exchange of HIPPAA transactions, these vendors [...]
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Posting Date: 09/26/2024
MLN Connects® Newsletter: September 26, 2024
MLN Connects® Newsletter: September 26, 2024 News CMS Roundup (September 20, 2024) Cardiovascular Disease: Talk with Your Patients about Screening Claims, Pricers, & Codes Cardiology CPT Code 75580: Issue with Claims Returned to [...]
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Posting Date: 05/11/2018
Medically Unlikely Edits and Related Billing Clarifications
Medically Unlikely Edits and Related Billing Clarifications An MUE is the maximum number of UOS allowable under most circumstances for a single HCPCS/CPT code billed by a provider for a particular date of service for a single beneficiary. [...]
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Posting Date: 10/28/2021
Medical Review Targeted Probe and Educate ADRs
Medical Review Targeted Probe and Educate Additional Development Requests Medical Review NGS Medical Review Department will be performing service specific post-payment reviews for a random selection of claims billed to Medicare Part A and B. [...]
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Posting Date: 02/24/2021
General Information
General Information In certain circumstances, National Government Services or other contractors working under the CMS may need to request additional information with regard to claims submitted to the Medicare Program. The requests for [...]
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Posting Date: 10/28/2021
Ways to Respond to ADRs
Ways to Respond to ADRs Table of Contents Ways to Respond to ADRs Utilizing Paperwork Segment and esMD Electronic Submission of Medical Documentation NGSConnex Portal Fax U.S. Mail, FedEx, UPS [Return to Top] Ways to Respond to ADRs [...]
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Posting Date: 10/28/2021
Claim ADRs
Claim Additional Development Requests National Government Services will not be able to process your claim without additional documentation. The following are the most common situations when NGS would require additional documentation to process [...]
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Posting Date: 10/28/2021
Other Audit Contractor ADRs
Other Audit Contractor Additional Development Requests An ADR may be requested from one of the contractors listed below. If you receive correspondence from any one of these contractors, please follow the instructions within their letter. [...]
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Posting Date: 10/28/2021
Overpayments Due to Contractor Audit Reviews
Overpayments Due to Contractor Audit Reviews If you do not agree with any CMS contractor audits determination and you are a provider practicing in JK (CT, MA, ME, NH, NY, RI, VT) or J6 (IL, MN, WI), you may use the Medicare appeals process [...]
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Posting Date: 10/08/2021
Bone Mass Measurements
Preventive Services Guide Bone Mass Measurements Table of Contents Bone Mass Measurements Risk Factors Coverage Guidelines and Frequency Limits Coverage Criteria HCPCS/CPT Coding HCPCS/CPT Codes ICD-10 Codes Diagnosis [...]
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Posting Date: 09/26/2024
Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line
Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line Attention: Provider Enrollment and Credentialing Departments Revalidate before your due date to avoid a “Stay of Enrollment” or claim rejections which may [...]
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Posting Date: 09/26/2024
Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line
Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line Attention: Provider Enrollment and Credentialing Departments Revalidate before your due date to avoid a “Stay of Enrollment” or claim rejections which may [...]
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Posting Date: 10/06/2021
Hepatitis B Virus Screening
Preventive Services Guide Hepatitis B Virus Screening Hepatitis B is a virus that can damage the liver, it is spread through contact with infected blood or body fluids and can be transmitted through sex with an infected person or by sharing [...]
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Posting Date: 10/06/2021
Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
Preventive Services Guide Screening for Sexually Transmitted Infections and HIBC to Prevent STIs Table of Contents Screening for Sexually Transmitted Infections Coverage Criteria High/Increased Risk Factors Frequency Limits [...]
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Posting Date: 05/14/2018
Hospice Claim Reporting Requirements for Attending and Certifying Physicians
Hospice Claim Reporting Requirements for Attending and Certifying Physicians Under CMS' current guidelines, the hospice medical director or the hospice physician and the attending physician (if the beneficiary has one), must initially [...]
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Posting Date: 09/27/2024
LCD and Article Updates for September/October 2024
LCD and Article Updates for September/October 2024 A58152 Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP) The following ICD-10-CM diagnosis codes were added to Group 1- ICD-10-CM Codes That Support Medical necessity [...]
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Posting Date: 10/08/2021
Cardiovascular Disease Screening Tests
Preventive Services Guide Cardiovascular Disease Screening Tests Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Table of [...]
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