38312

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim.   To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]

APPLICATION FEE: What is the amount of the application fee?

APPLICATION FEE: Who needs to pay an application fee?

APPLICATION STATUS: Where can I find the status of a submitted application?

Provider Contact Center

Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Written Correspondence and Inquiries [...]

Provider Contact Center

Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Written Correspondence and Inquiries [...]

ASCA: Where do we mail our Administrative Simplification Compliance Act (ASCA) waiver request?

ASCA: What kind of supporting documentation should I attach to my Administrative Simplification Compliance Act Waiver Request?

ASCA: When applying for an ASCA waiver, do I need to complete the Waiver Request form for each provider number?

ASCA: Must an Administrative Simplification Compliance Act waiver be mailed or can it be faxed?

ASCA: If my Administrative Simplification Compliance Act Waiver Request is denied, what will happen to my paper claims?

ASCA: How will the Administrative Simplification Compliance Act enforcement review affect me as a “small provider/supplier?” Will I be required to submit claims electronically?

ASCA: How will I know the outcome of my Administrative Simplification Compliance Act waiver request form?

ASCA: I was under Administrative Simplification Compliance Act review once and received an approved waiver request to send paper claims, why am I under review again?

DDE: My name changed and I need to change the name associated to my log on ID. How do I do that?

DDE: Is there some place on FISS/DDE that shows how many physical therapy (PT) or occupational therapy (OT) visits the beneficiary has had?

DDE: I tried to access my claim through the FISS/DDE system and it will not let me pull it up. What is the problem?

DDE: How do I get my log on ID password reset?

DDE: Can a provider view additional development requests (ADRs) via the FISS/DDE?

DDE: I have a claim which was fully denied and I am attempting to use the automated denial adjustment process, but the FISS/DDE system is not allowing me to adjust my claim. Why am I not able to bring up my claim and submit the adjustment?

CLAIMS: Why would my postoperative claims deny?

CLAIMS: Where are comments entered on the 837P electronic claim form?

CLAIMS: When submitting an ambulance claim, do the base and mileage codes need to have the same ZIP code for the same trip?

CLAIMS: What is the correct way to submit a beneficiary name on a claim?

CLAIMS: On a screening Pap smear test claim, which pointer does my diagnosis code need to be in?

CLAIMS: Medicare is the beneficiary's secondary payer and I am receiving denials when submitting using the CMS-1500 form. How can I resolve this?

CLAIMS: I file all my Medicare claims electronically except for Medicare Secondary Payer (MSP) claims because I thought I had to attach the primary Explanation of Benefits (EOB). Is this the correct process?

CLAIMS: I received a denial stating that the documentation submitted did not support the medical necessity of laboratory services. Can you tell me what I can submit to support these services?

CLAIMS: How do I submit documentation for an additional development request (ADR)?

CLAIMS: I am receiving inconsistent payments on claims billed for the same drug. How can I prevent this?

CLAIMS: How do I prevent monthly End Stage Renal Disease claims from denying?

CLAIMS: How do I know if a HCPCS/CPT code is subject to MUE (medically unlikely edit)?

CLAIMS: How do I indicate on a Medicare claim that the services are NOT related to a liability, no fault (including medical payment) or Workers’ Compensation accident, injury or illness MSP record in the CWF?

CLAIMS: During the patient check in process, may we have the patient check a box on a form at each visit stating they agree to allow us to bill Medicare and have that serve as the patient’s acceptance for our filing a claim?

When billing for waste on a single use vial would you round units up or down for a half unit?

When billing an unclassified drug code such as J3490, are the units of service on the claim always equal to one?

What is the proper way to submit professional physician claim with multiple NDC numbers for the same drug code?

J3357, Ustekinumab (Stelara) is listed on the Self-Administered Drug Exclusion List: Medical Policy Article A53021, and it says “acceptable”. Does this mean it is excluded or not?

What is the correct way to bill an unlisted drug or biological?

Is the shingles vaccine covered by Medicare?

Is the GY modifier required on the drug code and the administration code for noncovered self-administered drugs?

Have the payable diagnoses for IVIG and Rituximab changed? I don’t see all of the previously payable diagnoses in the applicable drug local coverage determinations (LCDs) and articles.

How do I bill a bilateral joint injection and HCPCS J1040 for two units?

Do all established drug HCPCS codes require the dosage amount in its description on the claim?

Does the waste with the JW modifier appended always go on the second line regardless of the billed amount? For example, the billed amount for the waste is higher than the administered amount.

Are unclassified drug codes included in average sales price (ASP) files?

Can chemotherapy be split into two doses on two different dates of service if the patient was unable to complete a full dose in one day? For example, the patient's port was not functioning properly.

Does Medicare Part B make payment for the unused portion of a multi-dose vial of a drug/biological?

Can Medicare Part B providers who bill on the professional CMS-1500 claim form, and electronic equivalent, bill unclassified drug code C9399?

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

MEDICAL REVIEW: Why did I receive a Comparative Billing Report?

MEDICAL REVIEW: Where can I get answers to billing questions?

MEDICAL REVIEW: Where can I find more details about the reasons my claims were denied?

MEDICAL REVIEW: What constitutes a valid signature?

MEDICAL REVIEW: What mailing address does NGS use to send Medical Review additional documentation requests (ADRs) to providers?

MEDICAL REVIEW: We are a large group and could potentially have many providers on TPE review. We have difficulty managing the process for each provider. Does NGS have any guidance for large groups?

MEDICAL REVIEW: The Medical Review Department did a post payment review of my Medicare claim and it was denied. How do I pay the money back to NGS Medicare?

MEDICAL REVIEW: My claim was denied “56900 Documentation not received”; however, I did send in documentation. What now?