Search Results - NGSMEDICARE

Posting Date: 04/07/2025

37098

Avoiding/Correcting This Error Verify billing and, if appropriate, correct and return the claim. Related Content Billing for FQHC MAO Plan Supplemental Payment (PPS Providers) CMS Internet-Only Manual 100-04, Medicare Claims Processing [...]

Posting Date: 04/07/2025

32402

Avoiding/Correcting This Error Verify HCPCS code using the FISS DDE Inquiries HCPCS file (option 14) to determine the allowable revenue codes based upon the date of service. Verify billing and, if appropriate, correct the claim using the [...]

Posting Date: 04/07/2025

55B31

Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity. When you receive an ADR from National Government [...]

Posting Date: 04/07/2025

59132

Avoiding/Correcting This Error RHCs should not bill codes G0108 or G0109. Related Content CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 9, Section 70.5 - Diabetes Self-Management Training (DSMT) [...]

Posting Date: 04/07/2025

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Verify the admission date, from, and through dates on the claim and compare the dates to the [...]

Posting Date: 04/07/2025

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Verify the admission date, from, and through dates on the claim and compare the dates to the [...]

Posting Date: 04/07/2025

U5220

Avoiding/Correcting This Error Verify the MBI and date(s) of service. If services were provided prior to the date the beneficiary was entitled to Medicare, no further action is necessary. Otherwise, correct and resubmit.

Posting Date: 04/07/2025

U538Q

Avoiding/Correcting This Error Medicare does not pay for medical items/services furnished to an alien beneficiary who was not lawfully present in the United States on the date of service that the items/services were furnished. Related Content [...]

Posting Date: 04/07/2025

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS/DDE Provider Online System or NGSConnex to verify [...]

Posting Date: 04/07/2025

C7010

Avoiding/Correcting This Error If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient). Verify hospice enrollment prior to claim submission by reviewing the CWF, the [...]

Posting Date: 04/07/2025

34293

Avoiding/Correcting This Error Review your beneficiary’s enrollment in a Medicare HMO/MAO prior to providing services. A beneficiary may drop MAO coverage; review the CWF, IVR, NGSConnex, or HETS to identify a termination date for the MAO [...]

Posting Date: 04/07/2025

C7010

Avoiding/Correcting This Error If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient). Verify hospice enrollment prior to claim submission by reviewing the CWF, the [...]

Posting Date: 04/07/2025

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider [...]

Posting Date: 04/07/2025

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

Posting Date: 04/07/2025

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

Posting Date: 04/07/2025

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the IVR system, the [...]

Posting Date: 04/07/2025

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

Posting Date: 04/07/2025

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

Posting Date: 04/07/2025

3/13/2025 Part B POE Advisory Group Meeting

3/13/2025 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Doris Barnes, Aurelia Barraco, Brenda Bedard, Sheila Bembeneck, Madelon Berger, Todd Bergstrom, Kimberly Bischel, Mollie [...]

Posting Date: 04/14/2022

Meeting Minutes

Meeting Minutes Jurisdiction 6 and Jurisdiction K Combined Meeting 3/13/2025 Meeting 12/12/2024 Meeting 9/18/2024 Meeting 6/12/2024 Meeting

Posting Date: 04/07/2025

CO-22

Avoiding/Correcting This Error During patient registration it’s important for office staff to identify whether a beneficiary’s claims should be covered by other insurance before, or in addition to, Medicare. Providers shall use our [...]

Posting Date: 04/08/2025

New Version of PC-ACE: April 2025

New Version of PC-ACE: April 2025 PC-ACE Version 6.6 contains several CMS mandates and product enhancements including but not limited to the items listed below. 13891 – Implement Operating Rules – Phase III Electronic Remittance Advice [...]

Posting Date: 06/14/2023

Meeting Minutes

Meeting Minutes Jurisdiction 6 Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Island, Oregon, Puerto Rico, U.S. Virgin Islands, Washington and Wisconsin [...]

Posting Date: 04/01/2025

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the MAO/HMO entitlement dates. Outpatient facilities and IPPS and IRF hospitals, or LTCH billing services within an [...]

Posting Date: 04/01/2025

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Outpatient facilities and inpatient noninpatient PPS and IRF hospitals, or LTCH billing [...]

Posting Date: 04/01/2025

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

Posting Date: 04/01/2025

7K073

Avoiding/Correcting This Error If the beneficiary is entitled to Medicare Part B, an ancillary claim may be submitted to your MAC. Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]

Posting Date: 04/01/2025

C7010

Avoiding/Correcting This Error If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient). Verify hospice enrollment prior to claim submission by reviewing the CWF, HETS [...]

Posting Date: 04/01/2025

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS/DDE Provider Online System, HETS or NGSConnex to verify [...]

Posting Date: 04/01/2025

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

Posting Date: 04/01/2025

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider Online System, HETS or NGSConnex to verify beneficiary [...]

Posting Date: 04/01/2025

7K073

Avoiding/Correcting This Error If the beneficiary is entitled to Medicare Part B, an ancillary claim may be submitted to your MAC. Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]

Posting Date: 04/01/2025

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

Posting Date: 04/01/2025

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider [...]

Posting Date: 04/01/2025

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

Posting Date: 04/01/2025

38200

Avoiding/Correcting This Error Always verify the status of a submitted claim before submitting another claim. Verify claim status using the IVR system, FISS/DDE or the NGSConnex online portal. Per CMS mandate, PCC representatives are not [...]

Posting Date: 04/01/2025

38032

Avoiding/Correcting This Error If duplicate claim was submitted in error, no additional provider action is necessary. If it is determined that the claim was due to additional charges for a patient for a specific date of service, wait for the [...]

Posting Date: 04/01/2025

38312

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim. To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]

Posting Date: 04/01/2025

38105

Avoiding/Correcting This Error Verify billing and if appropriate, correct and resubmit the claim. To prevent this error on future claims: Ensure that the correct bill type is submitted once you have received all charges from all [...]

Posting Date: 04/01/2025

38032

Avoiding/Correcting This Error If duplicate claim was submitted in error, no additional provider action is necessary. If it is determined that the claim was due to additional charges for a patient for a specific date of service, wait for the [...]