Top Customer Care Written Inquiries

Illinois and Wisconsin

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
Duplicate Remittance Notice
Appeals
Misrouted telephone/Written Correspondence
Contractual Obligation Not Met
Other Issues
Billing Issues
Denial Letter Request
Overpayments
Benefits/Exclusions/Coverage Criteria/Rules

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.
Duplicate Remittance Advice	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.
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: Illinois/Wisconsin PCC: 877-309-4290 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.
Misrouted Telephone/Written Correspondence	If the PCC or another National Government Services department contacts your facility in error with information for another facility, you must immediately notify the caller that they have reached the wrong provider. If written correspondence is sent to you in error do not forward to the provider on behalf of the sender. The correspondence must be returned to the institution from which it was sent. You can access contact information in the Resources > Contact Us section of the National Government Services Web site.
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.
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/.
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.
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.
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.
Benefits/Exclusions/Coverage Criteria/Rules	Local coverage determination (LCD) information can be accessed in the Medical Policy Center of the National Government Services Web site. You can also access the CMS Internet-Only Manual (IOM) Publication 100-03, Medicare National Coverage Determinations Manual on the CMS Web site.

(Date Last Reviewed: 08/01/2012)