Guidelines for Submitting Prior Authorization Certain Hospital Outpatient Department

General PAR Documentation Requesters must include the following data elements in all PARs to avoid potential delays in processing. Your MAC may request additional, optional elements for submission of the PAR. Initial Submission Documentation: [...]

Interim Rate Review Documentation Request Form for Hospitals

Hospice PIP Rate Review Form

Submitting Credit Balance Reports

Submitting Credit Balance Reports Table of Contents Submitting Credit Balance Reports Initiate a Credit Balance Report Credit Balance Certification Page [Return to Top] Submitting Credit Balance Reports This function allows [...]

Initiate Audit and Reimbursement Document Submissions

Initiate Audit and Reimbursement Document Submissions Table of Contents Initiate Audit and Reimbursement Document Submissions Step 1: Provider Details Step 2: Audit & Reimbursement Step 3: Document Submission Step 4: Submit [...]

A&R Inquiries

A&R Inquiries Table of Contents A&R Inquiries Email Notification View/Initiate an A&R Inquiry Response Inquiry Details Step 1: Response Description Step 2: Attachments Step 3: Submit Response What to do if you [...]

Initiate a Prior Authorization Request

Initiate a Prior Authorization Request Table of Contents Initiate a Prior Authorization Request Request Details Requestor’s Information Rendering Physician Information Attachments [Return to Top] Initiate a Prior Authorization [...]

DSMT: Documentation & Physician Order Requirements

DSMT: Documentation & Physician Order Requirements Table of Contents DSMT: Documentation & Physician Order Requirements Documentation & Physician Order Requirements Provider Actions Related Content [Return to Top] DSMT: [...]

Claim Timely Filing Job Aid

Claim Timely Filing Job Aid Table of Contents Claim Timely Filing Job Aid Timely Filing Limits Date of Service Considerations Timely Filing Limits Chart Timely Filing Exceptions Related Content [Return to Top] [...]

A/B and DME Collaborative General Documentation Requirements

A/B and DME Collaborative General Documentation Requirements The A/B and DME Collaborative General Documentation Requirements YouTube Video is available. Posted 3/27/2024

NGSConnex Part B Claim Submission Issue – Mammography Claims

NGSConnex Part B Claim Submission Issue - Mammography Claims At this time, we are unable to accept mammography claims through Part B Claim Submission in NGSConnex. We are working to resolve the issue; please watch for Email Updates on the [...]

MLN Connects® Newsletter: March 28, 2024

MLN Connects® Newsletter: March 28, 2024 Proposed Payment Rule FY 2025 Inpatient Rehabilitation Facility Prospective Payment System Proposed Rule News CMS Roundup (Mar 22, 2024) Hospital Price Transparency: Tools to Help Hospitals [...]

April 2024

In This Issue National Government Services Articles for Part A and Part B Providers Attention Electronic Billers Attention! New CMS-588 Electronic Funds Transfer Authorization Agreement (11/23) Version Important Reminder: Change [...]

Submitting a Medicare GME Affiliation Agreement

Submitting a Medicare GME Affiliation Agreement Table of Contents Submitting a Medicare GME Affiliation Agreement Jurisdiction K MAC (NGS) Jurisdiction 6 MAC (NGS) Submitting a Medicare GME Affiliation Agreement In [...]

Rural Health Claims Impacted by FS2540

This utility will adjust Rural Health claims - 71X TOB Reimbursed incorrectly with the implementation of FS2540 in the A20232CP release Installed to production on 5/15/23 Note: changes for FS2540 were backed out with FS2540R1 on 6/13/23. [...]

Part A Claims Returning to Provider (RTP) RC 38361

Claims are continuing to incorrectly RTP even when the prior claims are not No Pay Claims.

RC 55A00 or 55A01 Denials for Denosumab

National Government Services is aware of an issue that is causing claims to deny in error with reason code 55A00 or 55A01. The claims involved are for Denosumab (J0897) - Billing and Coding article – A52399 and are firing on edit 5XX84.