Top Customer Care Written Inquiries

Connecticut and New York

The following chart provides a listing of the top ten provider customer care written inquiries and suggestions for locating this information. Please use the following inquiry type links to navigate to information of interest in the chart below.

Status/Explanation/Resolution
Issue Not Identified/Incomplete Information
Appeals
Billing Issues
Other Issues
Overpayments
Contractual Obligation Not Met
Filing/Billing Instructions
Denial Letter Request
Duplicate Remittance Notice

Type of Inquiry	How to Locate This Information
Status/Explanation/Resolution	Providers can use the Fiscal Intermediary Standard System (FISS)/Direct Data Entry (DDE) Provider Online System to obtain information and explanation on the status of a claim. To view the reason code narrative online: While in the claim, press <F1>/<PF1> and the system will present the reason code and narrative. Note that if multiple reason codes apply to the claim, only the first reason code will be viewable. To view the additional reason codes: While in the reason code file, type another reason code over the reason code listed and press <Enter>. To return to the claim, press <F3>/<PF3>. The reason code will provide details as to whether the provider must correct and resubmit the claim, submit an adjustment or take other action.
Issue Not Identified/Incomplete Information	When sending in a written inquiry providers should send enough information for the problem/issue to be researched. If asking for information regarding claim status, appeal status or any other information regarding specific claims the request must include patient name, Health Insurance Claim number (HICN) and dates of service. If requesting information regarding remittance advice or other provider specific information the request must include the provider name, address, and number.
Appeals	The Provider Contact Center (PCC) assists with general information regarding appeals. This information is not available through the interactive voice response (IVR) system. Contact the PCC at the number designated for your state: Connecticut/New York PCC: 888-855-4356 These numbers will connect directly to a PCC customer care representative. Be advised that if the question being asked is one that can be answered by the IVR, the PCC representative will redirect the call back to the IVR Additional information can be found in the Appeals Section of the National Government Services Web site.
Billing Issues	For general billing questions contact the PCC either by phone or in writing. You can access contact information in the Resources > Contact Us section of the National Government Services Web site. Your first contact for general billing information should always be the PCC.
Other Issues	Providers may obtain general Medicare information from the National Government Services Web site or by visiting the Centers for Medicare & Medicaid Services (CMS) Web site at http://www.cms.gov/.
Overpayments	The Immediate Recoupment Request - Electronic/E-mail Form can be accessed from the Resources > Forms section of our Web site. Once you complete and submit the Immediate Recoupment Request - Electronic/E-mail Form, you will receive a confirmation e-mail of your submission. Once you receive your confirmation e-mail, no additional follow-up notices will be issued regarding your request. Any money recouped through the immediate recoupment process (i.e., fax, mail, electronic/e-mail form) will be indicated on your remittance advice. You may also complete the hard-copy Immediate Recoupment Request Form.
Contractual Obligation Not Met	Providers seeking information about claim(s) denied because the provider did not comply with their Medicare contractual obligation (for example, the claim was submitted with missing information, the claim was not filed timely, etc). Providers can use the FISS/DDE Provider Online System to obtain information and explanation on the status of a claim. To view the reason code narrative online: While in the claim, press <F1>/<PF1> and the system will present the reason code and narrative. Note that if multiple reason codes apply to the claim, only the first reason code will be viewable. To view the additional reason codes: While in the reason code file, type another reason code over the reason code listed and press <Enter>. To return to the claim, press <F3>/<PF3>. The reason code will provide details as to whether the provider must correct and resubmit the claim, submit an adjustment or take other action.
Filing/Billing Instructions	Please refer to claims completion and formatting instructions in the CMS Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 25, Section 75. (472 KB)
Denial Letter Request	Denial letter requests must be in writing. Requests should be sent to the address listed for the provider’s state or region. A list of addresses for written inquiries is located in the Resources > Contact Us section of the National Government Services Web site.
Duplicate Remittance Notice	To receive a duplicate remittance, providers must complete the Remittance Advice Request Form. Complete a separate form for each remittance advice being requested and submit it with your check or money order to the address on the form.

Date Last Reviewed: 7/1/2015