HHS-690 Assurance of Compliance

CMS-1539 Medicare/Medicaid Certification and Transmittal

CMS-1561 Health Insurance Benefit Agreement

Pneumococcal Vaccine

Pneumococcal Vaccine Frequently Asked Questions

Pneumococcal Vaccine Frequently Asked Questions We’ve added new frequently asked questions to our website. View answers to common questions about Pneumococcal Vaccine to ensure you have the information needed to properly submit claims for [...]

CERT Text Part B

Need to Appeal a CERT Denial? Log onto our secure NGSConnex online Web application and quickly file an appeal. Submitting an appeal electronically saves postage, print and mail costs and is easy to do through NGSConnex.com. If you do not [...]

Attention All Medicare Providers: Are You Using an Outsource Company?

Attention All Medicare Providers: Are You Using an Outsource Company? Do you use an outsource company for your Medicare billing and account receivables? Do you know who is using your data? Do you know how they are using your data? How much is [...]

Prior Authorization Exemption: 56900 Denials Alert

Prior Authorization Exemption: 56900 Denials Alert NGS PA department has denied claims due to non-responses related to the postpayment ADR review for the Exemption process. Providers may submit the necessary documentation to the NGS PA [...]

October and November 2022 Billing and Coding and Medical Policy Article Updates

October and November 2022 Billing and Coding and Medical Policy Article Updates Retired article: Billing and Coding: Complex Drug Administration Coding (A58620) Revised articles: Billing and Coding: Molecular Pathology Procedures [...]

Notice of Local Coverage Determination Retirement

Notice of Local Coverage Determination Retirement Based on comments received at our Open Meeting on 10/20/2022, National Government Services has decided to retire the Proposed LCD DL38262 Salvage High-intensity Focused Ultrasound (HIFU) [...]

MLN Connects® Newsletter: October 27, 2022

MLN Connects® Newsletter: October 27, 2022 News COVID-19 Updated Booster Vaccines Covered Without Cost-Sharing for Eligible Children Ages 5–11 Oversight of Nation’s Poorest-Performing Nursing Homes Initial Nursing Facility Evaluation [...]

November is Lung Cancer Awareness Month

November is Lung Cancer Awareness Month Did you know that cigarette smoking is the number one risk factor for lung cancer? In the United States, cigarette smoking is linked to about 80% - 90% of lung cancer deaths. Lung cancer is the third [...]

340B-Acquired Drugs Payment Differential Cancellation

Previously applied differential payment rates for 340B-acquired drugs are no longer valid as of 9/28/2022, as per a ruling by the United States District Court for the District of Columbia. As a result, the CMS will revert to paying the default [...]

Comprehensive Error Rate Testing

MLN Connects® Newsletter: Final Rules

MLN Connects® Newsletter: Final Rules Final Rules Calendar Year (CY) 2023 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements ​​​​​​​ CY 2023 End-Stage Renal Disease (ESRD) Prospective [...]

Coming Soon ‒ The CY 2023 Medicare Physician Fee Schedule

Coming Soon ‒ The CY 2023 Medicare Physician Fee Schedule The CY 2023 MPFS will soon be available on the Fee Schedule Lookup tool located on NGSMedicare.com, after the CY 2023 physician fee schedule regulation is put on display. Once the Fee [...]

Assistant at Surgery Billing Documentation Reminder

Assistant at Surgery Billing Documentation Reminder Claims for assistant at surgery with a zero (0) indicator in the MPFSDB must have information to support and identify the assistant and also support the medical necessity of his/her [...]

MLN Connects® Newsletter: November 3, 2022

MLN Connects® Newsletter: November 3, 2022   News COVID-19 Vaccine: Novavax Booster Authorized Medicare Part B Immunosuppressive Drug: Get Information on New Benefit Part B Immunosuppressive Drug Benefit: Check Medicare Eligibility [...]

Claims Frequently Asked Question

Claims Frequently Asked Question We have added a new FAQ to our website. View answers to a common question about how to bill for services unrelated to a liability, no fault, or workers compensation claim to ensure you have the information [...]

Announcement About Medicare Participation for Calendar Year 2023

Announcement About Medicare Participation for Calendar Year 2023 The Centers for Medicare & Medicaid Services has posted the Announcement About Medicare Participation for Calendar Year 2023. Posted 11/3/2022

Revalidate Provider Enrollment

This section gives you access and education about revalidating your enrollment.

Electronic Funds Transfer

[Element key="Body" type="content" context="selected" name="ngsmedicarecontentnew/ngsmedicarenew/enrollment/enrollment tasks/a_set up eft" id="f2538eab-3d5a-4e3b-bc3d-ce4037b05d26:MS9uZ3NtZWRpY2FyZWNvbnRlbnRuZXcvbmdzbWVkaWNhcmVuZXcvZW5yb2xsbWVud[...]

Go Electronic

This section gives you access/education about first time Enrollment.

Rebuttal

This section gives you access/education about first time Enrollment.

Appeals

This section gives you access/education about first time Enrollment.

NGSConnex Feedback

NGSConnex Feedback After you log into NGSConnex, each page contains a Feedback button. If you experience issues while using NGSConnex, please use the Feedback to let us know.  Your feedback allows us to begin essential research and [...]

MLN Connects® Newsletter: November 10, 2022

MLN Connects® Newsletter: November 10, 2022     News Teaching Hospitals: Phase 2 Section 131 Reviews — Submission Deadline November 18 Medicare Participation for CY 2023 CMS Innovation Center’s Strategy to Support [...]

Transplant Services

Verify Bank Account Information

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 [...]

About Medicare Remit Easy Print

About Medicare Remit Easy Print Print Your ERA Using Medicare Remit Easy Print If you are still using SPR, you can save time and money by taking advantage of free MREP software. MREP software is an option available for providers to view and [...]

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 Appeals

About Appeals Providers and beneficiaries have the right to appeal claim determinations made by National Government Services. The purpose of the appeals process is to ensure the correct adjudication of claims. Appeals activities conducted by [...]

What Documents are Needed

What Documents are Needed? You are required to submit all necessary medical documentation to support the services billed on your claim as part of your participation agreement; you must submit a complete medical record when requesting an [...]

PCACE Download Email

Thank you for downloading the full installation or upgrade for PC-ACE. Please print this e-mail and keep this for your records. The PC-ACE installation code is: NGSMAC1 Once you have successfully installed or upgraded PC-ACE, the “Sign On” [...]

Tutorial

Centers for Medicare & Medicaid Services

Centers for Medicare & Medicaid Services CMS has ten regional offices to assist with Congressional inquiries. For Congressional inquiries or questions specific for Medicare Part D, try contacting the Medicare Part D Plan first. Another [...]

Credit Balance Status Lookup