Use Our Provider Self-Service Tools To Spend Less Time on the Phone

Did you know our PCC experiences high call volumes at the beginning and the ending of each month? To avoid experiencing prolonged hold times, you can use our provider self-service tools and resources to get the information you need. You can find information on our website:  

NGSConnex

• Our NGSConnex system (under Apps) – Use our free, secure, web-based application to verify patient eligibility, determine the status of your appeals or claims, respond to medical ADRs, submit credit balance reports, find financial information and more! Be sure to sign up for NGSConnex and review our NGSConnex User Guide.

Eligibility

• You can use the following resources to verify your patient’s Medicare entitlement eligibility (Part A, Part B, MAO plan enrollment, hospice, home health, MSP and more!): 
  • Our NGSConnex system (under Apps) – Review our NGSConnex User Guide (under Education > Manuals and Guides) to learn how.

Claim Status

• You can use the following resources to determine the status of your claims:

  • Our NGSConnex system (under Apps) – Review our NGSConnex User Guide (under Education > Manuals and Guides) to learn how.
  • Our FISS DDE system - Review our FISS DDE Provider Online Guide (under Education > Manuals and Guides) to learn how.      

Appeals/Appeal Status

• Appeals articles (under Resources > Claims & Appeals > Appeals) – Learn about who may file appeals, appeal levels and filing timeframes, documents needed and more!
• Appeals forms (under Resources > Forms > Appeals) – Find all appeals-related forms.
• Appeals calculator (under Resources > Tools & Calculators) – Determine timely filing dates.
• Our NGSConnex system (under Apps) – Review our NGSConnex User Guide (under Education > Manuals and Guides) to learn how to initiate and determine the status of your appeals.     

Production Alerts

• Our Production Alerts (under Resources) – Review alerts about our system or other incidents that may be causing issues with claim submission and/or processing.

FISS/DDE

• FISS DDE Provider Online Guide (under Education > Manuals and Guides) – Learn how to submit claims, determine the status of your claims, correct/adjust claims and more!  

Interactive Voice Response System

• IVR system contact number and tools (under Contact Us > IVR) – Our IVR system is available 24 hours a day, 7 days a week. Use it to determine the status of your appeals and claims, find information on checks, offsets, pricing, provider enrollment and more! Note: The CMS does not permit our PCC representatives to answer certain questions via phone when you can obtain those answers through self-service tools.

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In addition to using our website, you can use the CMS website to find the information you need.

Revised 11/18/2024