About Us

National Government Services, Inc., a subsidiary of Elevance Health, Inc., has a long history of supporting federal health agencies, including CMS. Throughout the country, NGS has served as a Medicare contractor since the inception of the [...]

REMITTANCE: What do the two-letter codes on my remittance advice mean?

REMITTANCE: Can I post the electronic remittance advice information into my accounts receivable system?

REMITTANCE: Do I need special computer software to use the electronic remittance advice?

REMITTANCE: How long will I receive paper remittances once I sign up for the electronic remittance advice?

REMITTANCE: If I have a computer problem while trying to download my electronic remittance advice, can I have it reposted to download again?

PC-ACE: Where can I find out more about the PC-ACE free billing software?

PC-ACE: Why did my PC-ACE software expire?

PC-ACE: Is there a resource I can use to assist me with Medicare Secondary Payer (MSP) claims when using PC-ACE?

PC-ACE: Why am I receiving security rights error/issue when installing PC-ACE?

PC-ACE: How often is the PC-ACE software upgraded?

PC-ACE: How do I determine the version of PC-ACE I am using?

LCD NCD: What are the differences between LCDs and NCDs?

PC-ACE: Where can I find out more about the PC-ACE free billing software?

PC-ACE: How do I correct a web browser error when downloading or making changes to the software?

PC-ACE: Is there a resource I can use to assist me with Medicare Secondary Payer (MSP) claims when using PC-ACE?

CAR-T: Will the Part A claim for CAR-T deny if it is submitted with the KX modifier?

CAR-T: Is the KX modifier required for Part A and Part B claims?

CAR-T: Is Risk Evaluation and Mitigation Strategy (REMS) verified by the facility’s site name or address?

CAR-T: What is the effective date for the requirement of the KX modifier for administration of CAR-T?

EDI: I heard that 5010 requires a physical address in box 33 and P.O. boxes are no longer accepted. Is this true?

EDI: How long are Electronic Remittance Advices (ERAs) available in my mailbox?

EDI: Is the 277CA returned for each test submission?

EDI: I am receiving the following CSC and EIC code on my 277CA. How do I make the correction?

EDI: How do I restore a remit file?

EDI: I am missing an Electronic Remittance Advice (ERA). How do I order a duplicate?

EDI: After I receive a 277CA will I receive anything else?

EDI: How can I tell if I am set up for electronic billing?

EDI: I am receiving the following Claim Status Code and EIC code on my 277CA. What do these codes mean?

EDI: I received a payer acknowledgement/acceptance report from my clearinghouse. Does this mean you accepted my claims?

EDI: I received my application back with errors on my Provider Authorization Form. Can I correct it or will I have to complete an entirely new application and authorization form?

EDI: What PTAN should I enter on the EDI enrollment forms if the provider is a member of a group?

EDI: What Entity Name should I enter on the EDI Enrollment Agreement form?

EDI: What is an Approved Entity?

EDI: What is a Network Service Vendor (NSV)?

EDI: What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance?

EDI: What provider address should I include on the EDI enrollment forms?

EDI: When is a provider authorization form required?

EDI: Will you reject claims with a P.O. Box in the billing provider address?

EDI: Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description?

EDI: Will you reject claims where the group number and policy number are the same values?

LCD NCD: How do I find out if an LCD or medical coverage policy has changed in my jurisdiction?

LCD NCD: What are Medical Policy Articles?

LCD NCD: Does NGS offer any other LCD resources?

LCD NCD: How do I search for an LCD if I do not know the LCD number?

LCD NCD: How can I view and comment on proposed LCDs?

LCD NCD: Can I request a change be made to a current LCD?

LCD NCD: How do I find LCDs?

Ambulance Duplicate Claim Denials

Ambulance Duplicate Claim Denials Duplicate trips may be reported on the same claim if the ZIP code for the point of pick-up for both trips is the same. If separate claims are submitted for the same beneficiary on the same day with the same [...]

Ambulance Transports Included in SNF Consolidated Billing

Ambulance Transports Included in SNF Consolidated Billing Transport Description Medical Necessity Met Ambulance Billing Modifiers and Other Considerations Who is Responsible for Payment? Reference(s) SNF to [...]

Top JK Part B Claim Errors are Available

Top JK Part B Claim Errors are Available We conduct a comprehensive data analysis on a quarterly basis to update and disseminate the latest insights on the most common claim errors. This initiative provides:  Claim Error Reason Code [...]

CO-16

Avoiding/Correcting This Error The MBI is necessary for all claims submitted to MAC. Claims without a correct MBI are rejected, requiring providers to verify and resubmit them. To avoid this, use the Eligibility Lookup in NGSConnex before [...]

CO-16

Avoiding/Correcting This Error The billing provider's information on the claim is missing or invalid. To avoid this error, ensure the following details are accurate and included: the billing provider's NPI, name, address, ZIP code, and phone [...]

CO-16

Avoiding/Correcting This Error This rejection is the result of submitting a CPT/HCPCS code without a required modifier. You are required to research the proper modifier to report with the CPT/HCPCS code then submit a new claim. Please use [...]

Ambulance Billing Guidance

Ambulance Billing Guidance Table of Contents Ambulance Billing Ambulance Billing HCPCS Codes How to Bill Units with Transpiration HCPCS Codes Using Ambulance Modifiers When Billing Transportation Indicators Related Content [Return [...]

Level 1: Redetermination Request Form

Ensure Accurate Provider Enrollment Information on File

Ensure Accurate Provider Enrollment Information on File ATTENTION: Claims and Provider Enrollment Verify that accurate provider enrollment information is on file with Medicare. Are you familiar with the details identified in the PECOS system [...]

Medical Review: Targeted Probe and Educate Review Topics

Jurisdiction K HHH Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Home Health Medical Necessity N/A 55H3V– The documentation did not support the medical [...]

Understanding the Approval Recommendation Process for Certified Providers

Understanding the Approval Recommendation Process for Certified Providers The certified provider completes and submits a CMS-855 enrollment application and all supporting documentation to its MAC, including any state require documentation [...]

CO-16

Avoiding/Correcting This Error Certain services require the name and NPI of the ordering or referring physician, depending on the service type. Definitions:  Referring physician: Requests an item or service for a Medicare beneficiary. [...]