Prior Authorization Requests Submitted by Exempt Providers Alert The National Government Services PA Department has observed an increase in submission of PAR for exempt providers. These submissions are from the HOPD and/or physician offices on [...]

Hospice Cap

Medicare Number

Chapter I: Online System Terminology Medicare Number Purpose The FISS DDE Provider Online System utilizes the terminology MBI to identify the beneficiary’s Medicare number. For the purpose of this manual, “Medicare [...]

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 [...]