End-Stage Renal Disease: Medicare Part A Quick Reference Manual

CMS FQHC and RHC Flexibilities to Fight COVID-19 Update

EDI Application Status Search Tool

End-Stage Renal Disease: Medicare Part A Quick Reference Manual

Physician Dialysis Services

Accessing NGSConnex from Outside the United States or US Territories

Accessing NGSConnex from Outside the United States or US Territories We have security protocols to safeguard PHI and PII any time someone accesses the NGSConnex portal from outside the United States. If you access NGSConnex from outside the [...]

Chronic Disease Management and Preventive Services Learning and Action Series

Chronic Disease Management and Preventive Services Learning and Action Series A Collaborative Learning Opportunity with the Medicare Administrative Contractors National Government Services, Novitas Solutions, Wisconsin Physician Services [...]

Claims/Attachments Submenu

  Chapter II: Online Menu Functions Overview Claims/Attachments Submenu Purpose The CLAIMS/ATTACHMENTS submenu is primarily used for data entry of claims. Influenza virus vaccine, pneumococcal pneumonia vaccine and COVID-19 vaccine [...]

Check Search

Check Search Select the Financials button on the home page. In the Select a Provider panel, click the Select button next to the applicable provider account. Select Checks/EFT or Special Checks from the Financial Options drop-down [...]

View Checks and Special Checks Search

View Checks and Special Checks Search Select the Financials button on the home page. In the Select a Provider panel, click the Select button next to the applicable provider account. Select Checks/EFT or Special Checks from the [...]

Reminder: Submitting Paper Claims

Reminder: Submitting Paper Claims All paper claims are required to be submitted on the original red/white CMS-1500 (02/12) claim form. To ensure our OCR system can process claims efficiently: Use Courier New font for computer-generated [...]

Hot Topics

Online Menu Selection Quick-Reference Guide

Chapter II: Online Menu Functions Overview Online Menu Selection Quick-Reference Guide Main Menu Option 01: Inquiries Main Menu Option 02: Claims/ Attachments Main Menu Option 03: Claims Correction Main Menu Option 04: [...]

Medicare Fee-for-Service Claims and the Sequestration Payment Adjustment Changes

Medicare Fee-for-Service Claims and the Sequestration Payment Adjustment Changes Just a reminder: The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare fee-for-service claims. As a result of [...]

MLN Connects® Newsletter: August 10, 2023

MLN Connects® Newsletter: August 10, 2023 News Immunization: Protect Your Patients Claims, Pricers, & Codes Outpatient Rehabilitation Claims with Reason Code W7072: Do You Need to Resubmit Claims? MLN Matters® Articles HCPCS [...]

Claim Summary (12)

Chapter IV: Inquiries Submenu (01) Claims Summary (12) Purpose The CLAIM SUMMARY option allows providers to access specific data from the claim record for pending and processed claims. Note: Claim Summary is an “inquiry-only” option. You [...]

ZIP Code File (19)

Chapter IV: Inquiries Submenu (01) ZIP Code File (19) Purpose A ZIP Code is a five-digit numeric code used to identify a provider’s location. The ZIP CODE FILE option allows you to verify the validity of the facility ZIP Code that may be [...]

OSC Repository Inquiry (1A)

Chapter IV: Inquiries Submenu (01) OSC Repository Inquiry (1A) Purpose An occurrence span code identifies a specific event that relates to the payment of the claim that spans several days. The dates identify the commencement and ending of [...]

Home Health Payment Totals (67)

Chapter IV: Inquiries Submenu (01) Home Health Payment Totals (67) Purpose This option is currently unavailable. Revised 8/16/2023

ANSI Reason Codes (68)

Chapter IV: Inquiries Submenu (01) ANSI Reason Codes (68) Purpose ANSI codes are used to explain the adjudication of a claim and are the CMS approved ANSI messages. ANSI reason codes and CMS message codes will appear in the body of the [...]

Check History (FI)

Chapter IV: Inquiries Submenu (01) Check History (FI) Purpose The CHECK HISTORY option allows providers to view their last three Medicare checks (payments). To access the CHECK HISTORY option from the FISS Online System INQUIRIES [...]

Beneficiary/CWF (10)

Chapter IV: Inquiries Submenu (01) Beneficiary/CWF (10) Purpose The purpose of the beneficiary screens is to provide access to all beneficiaries contained on the eligibility file. The provider can use this file to verify beneficiary data. [...]

MLN Connects® Newsletter: August 17, 2023

MLN Connects® Newsletter: August 17, 2023 News CMS.gov Website Refresh – Test Website Available for Feedback CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in Hawaii Due to Recent Wildfires Clotting [...]

Tracking my Enrollment Packet and Checking Status

Tracking my Enrollment Packet Once your packet is submitted (See the section on Submitting the Packet), a confirmation message is displayed on the screen with the assigned Packet ID (PID) number. The PID will be sent to the e-mail address [...]

I Am a Billing Service and “I Want to Connect Directly to the Part A FISS/DDE System”

I Am a Billing Service and “I Want to Connect Directly to the Part A FISS/DDE System” This selection will prompt you to complete the Logon Request Form. This option is for a third party who wishes to update an operator's contact information, [...]

Customer Experience Surveys

Customer Experience Surveys We are pleased to offer two new surveys for you to tell us about your experience with our Provider Contact Center. When you use our IVR system, access the survey from the main menu after you complete your [...]

Appeals

Appeals State MAC Appeals Address Qualified Independent Contractor Address and Phone Number Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Nevada, Northern Mariana Island, Oregon, [...]

Medicare Rights & Protections

Medicare Rights & Protections Appeals Process Quality of Care Complaints Quality Care Finder – Compare Health Care Providers and Plans

Prolonged Services: Comparative Differences of Face-to-Face/Non Face-to-Face CPT Codes

Prolonged Services: Comparative Differences Face-to-Face vs. Non Face-to-Face CPT Codes Face-to-Face ( CPT Codes 99354-99355, 99356-99357) Non Face-to-Face (CPT Codes 99358-99359) Have been [...]

Prolonged Services: Face-to-Face

Prolonged Services: Face-to-Face Coding Guidelines Counseling and Coordination of Care Office versus Hospital Setting Excluded Time Examples NGS JK MAC has noted an increase in claims representing face-to-face prolonged [...]

Tips to Ensure an Optimal NGSMedicare.com Experience

Tips to Ensure an Optimal NGSMedicare.com Experience Most of you are probably aware, but if not, on Friday, 5/14/2021, we launched our new combined homepage. These changes were a result of your feedback. You now only need to go to [...]

NGSMedicare Crosswalk Reference

Skilled Nursing Facility Patient Driven Payment Model Billing For Noncovered Days With An Occurrence Span Code 76

Skilled Nursing Facility Patient Driven Payment Model Billing For Noncovered Days With An Occurrence Span Code 76 The CR 11992 updated the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Sections 40.3.2 and 40.6 to [...]

FQHC PPS Calculator

There’s Still Time to Register – National Government Services Preventive Service Week

There’s Still Time to Register – National Government Services Preventive Service Week National Government Services Provider Outreach and Education Team is holding a Special Virtual Conference on Medicare Preventive Services. Join us on [...]

Testosterone Pellet Dosage

Testosterone Pellet Dosage The dosage approved by the US Food and Drug Administration for testosterone pellet replacement therapy in androgen-deficient males is 150 mg to 450 mg subcutaneously every 3-6 months. Effective for dates of [...]

Register for EDI

EDI Help Desk Information

EDI Help Desk Information Toll-Free Number Jurisdiction 6: 877-273-4334 Jurisdiction K: 888-379-9132 Hours of Operation Monday–Friday: 8:00 a.m.–5:00 p.m. ET * Closed for training on the 2nd and 4th Friday of the month from 12:00–4:00 [...]

FISS/DDE

Fiscal Intermediary Standard System/Direct Data Entry DDE is a process that allows remote users online connectivity to the FISS, or mainframe, used by National Government Services to process Medicare claims. FISS/DDE connectivity will allow [...]

FISS/DDE

Fiscal Intermediary Standard System/Direct Data Entry DDE is a process that allows remote users online connectivity to the FISS, or mainframe, used by National Government Services to process Medicare claims. FISS/DDE connectivity will allow [...]

FISS/DDE

Fiscal Intermediary Standard System/Direct Data Entry DDE is a process that allows remote users online connectivity to the FISS, or mainframe, used by National Government Services to process Medicare claims. FISS/DDE connectivity will allow [...]

Congressional Offices

The Congressional Affairs Outreach and Education team at National Government Services, Inc. is committed to ensuring that congressional offices receive a timely response to your inquiries and helpful Medicare information. For your convenience, [...]

Appeals

Appeals Reopenings Telephone Reopening Unit Jurisdiction 6 Telephone Reopening Unit Contact Number Hours of Service Illinois 877-867-3418, Press 1 8:00 a.m.–4:00 p.m. CT Closed for training on the [...]

Applying for an Extended Repayment Schedule

DRG (Pricer/Grouper) (11)

Chapter IV: Inquiries Submenu (01) DRG (Pricer/Grouper) (11) Purpose This option will be used by the provider to research PPS information as it pertains to an inpatient stay. To access the DRG (Pricer/Grouper) option from the FISS Online [...]

RSNAT Pre-Pay Review

RSNAT Pre-Pay Review The RSNAT PA program has two components, PAR or prepayment review, which suppliers are able to use their discretion on the path that best suits their workflow. If a RSNAT supplier chooses to forgo the PA process for [...]

Billing and Coding Article Update for August 2023

Billing and Coding Article Update for August 2023 Billing and Coding: Non-Invasive Vascular Studies (A56758) Effective 8/31/2023, the following ICD-10-CM codes were added to the "ICD-10-CM Codes That Support Medical Necessity" section (Group [...]

MLN Connects® Newsletter: August 24, 2023

MLN Connects® Newsletter: August 24, 2023 News Seasonal Flu Vaccine Pricing for 2023–2024 Season Expanded Home Health Value-Based Purchasing Model: July 2023 Interim Performance Reports, Post-Event Materials, & Comment on CY 2024 [...]

Unprocessable Claim Rejections and Corrections

Unprocessable Claim Rejections and Corrections Assigned and nonassigned services are considered unprocessable when incomplete or invalid information is detected in our claims processing system. Unprocessable claim is described in the CMS IOM [...]

Medicare Beneficiary Eligibility Checklist

Tip Sheet #1

National Government Services Office of Congressional Affairs Protocol: Tip Sheet #1 Medicare is changing and we live in a MAC world and this protocol explains the process to help you submit your Medicare constituent inquiries. Today, [...]

Multi-Factor Authentication

Multi-Factor Authentication Multi-factor authentication (MFA) is a second layer of security required by CMS to have online access to protected health information. The MFA screen will display every time you log in to NGSConnex. Each day [...]

View Remittance

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

Processing Drivers and System Claim Paths

Chapter I: Online System Terminology   Processing Drivers and System Claim Paths Purpose Claims that are filed through the FISS DDE Provider Online System follow a prescribed route referred to as a system claim path. Claim paths [...]

Claim Status and Location Codes

Chapter I: Online System Terminology Claim Status and Location Codes Purpose The purpose of the status and location is to route claims through FISS. The status describes the general condition of the claim (i.e., whether paid, denied, [...]

Main Menu

Chapter II: Online Menu Functions Overview FISS/DDE Main Menu Purpose The FISS/DDE MAIN MENU offers the following four submenu options: 01 – Inquiries 02 – Claims/Attachments 03 – Claims Correction 04 – Online Reports View [...]

Inquiries Submenu

Chapter II: Online Menu Functions Overview Inquiries Submenu Purpose The INQUIRIES submenu allows providers to perform research through various file options, such as the following: Beneficiary/CWF information Claim status DRG [...]

HCPCS Codes (14)

Chapter IV: Inquiries Submenu (01) HCPCS Codes (14) Purpose The purpose of the HCPC CODES option is to provide access to details related to the HCPCS codes available to be reported on a claim. HCPCS codes are five-digit alphanumeric [...]

DX/Proc Codes ICD-9 (15)

Chapter IV: Inquiries Submenu (01) DX/Proc Codes ICD-9 (15) Purpose The purpose of the DX/PROC CODES ICD-9 option is to provide a reference of ICD-9-CM code(s) used to identify a specific or various diagnosis codes or inpatient surgical [...]