MEDICAL REVIEW: How do I change my address and which address exactly am I changing to ensure receipt of the MR letters and ADRs?

MEDICAL REVIEW: How do I respond to an ADR Not In List?

MEDICAL REVIEW: How do I request an appeal on a claim reviewed by the Medical Review Department?

MEDICAL REVIEW: How do I appeal a claim that MR reviewed but went to a T status or R status because of a CWF issue after MR processed?

MEDICAL REVIEW: How can I use NGSConnex to respond to Medical Review additional documentation requests?

Resources

Resources You Can Help Your Patients Quit Tobacco Use Smoking Cessation Tools and Resources Smokefree.gov Centers for Disease Control and Prevention: Tips from Former Smokers campaign Centers for Disease Control and Prevention: Office on [...]

COVID-19 Vaccine and Monoclonal Antibody

COVID-19 Vaccine and Monoclonal Antibody With the end of the PHE, as of 5/11/2023, this information no longer applies. We will keep the information available for PHE-related services that occurred prior to the expiration date that have not yet [...]

Prepare and Submit an MSP Claim

Table of Contents Step 1: Determine if an MSP Claim Must be Submitted to Medicare Step 2: Check Medicare’s Eligibility Files via NGSConnex to Determine if There's Other Insurance Primary to Medicare Step 3: Prepare the MSP (Partial-Payment [...]

837D Edit Spreadsheet

Expedited Requests

Expedited Requests The requester may submit for an expedited review of the PAR if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function. If the medical documentation does [...]

NGS Review of Prior Authorization Request

NGS Review of Prior Authorization Request Table of Contents NGS Review of Prior Authorization Request Number of Trips Extended Affirmation Periods for Beneficiaries with Chronic Conditions Decision Letters Resubmitting a Prior [...]

About Hospital OPD PA Model

About Hospital OPD PA Model Table of Contents About Hospital OPD PA Model General Information Related Content [Return to Top] About the Hospital OPD PA Model CMS implemented a PA program for certain hospital OPD services for DOS on [...]

Documentation Information

Documentation Information It is recommended that PARs are submitted at least seven calendar days prior to the expected date of service to allow National Government Services the full standard timeframe to receive and review requests. For [...]

Safeguard Your Finances: Know Your Provider Enrollment Revalidation

Safeguard Your Finances: Know Your Provider Enrollment Revalidation  Attention: Provider Enrollment and Credentialing Teams Ensure you revalidate before your deadline to prevent a "Stay of Enrollment" or claim rejections, which could [...]

Office/Outpatient Evaluation and Management Visit Complexity Add-on Code G2211

Office/Outpatient Evaluation and Management Visit Complexity Add-on Code G2211 Effective 1/1/2024 Definition of G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing [...]

Provider Enrollment: Top Reasons Behind Delays in Processing the Application

Provider Enrollment: Top Reasons Behind Delays in Processing the Application Medicare enrollment plays a vital role in ensuring compliance with CMS requirements. To help streamline the process and achieve the best results, it's important to [...]

Fiscal Intermediary Standard System Direct Data Entry Screen Changes – April 2025

Fiscal Intermediary Standard System Direct Data Entry Screen Changes – April 2025 The April 2025 quarterly system release will update FISS DDE as described below: Inquiries Submenu (01) Option 1C (CMHC Payment Totals)/MAP1D62 - Monetary [...]

Tobacco Cessation and Cognitive Behavioral Therapy

Tobacco Cessation and Cognitive Behavioral Therapy CBT is a type of psychotherapy that’s problem oriented. It may help your patients learn how to change unhelpful or unhealthy ways of thinking, feeling and behaving especially when related to [...]

Provider Enrollment: Top Reasons Behind Delays in Processing the Application

Provider Enrollment: Top Reasons Behind Delays in Processing the Application Medicare enrollment plays a vital role in ensuring compliance with CMS requirements. To help streamline the process and achieve the best results, it's important to [...]

MCReF Hospice Cap Functionality

MCReF Hospice Cap Functionality Attention Hospice providers: The new MCReF Hospice Cap functionality will be covered in the upcoming MCReF Webinar scheduled for 3/19/2025, from 1:00 – 3:00PM ET.  The Hospice Cap provider community is [...]

Hospital Inpatient or Observation Evaluation and Management Add-On Code G0545 for Infectious Diseases

Hospital Inpatient or Observation Evaluation and Management Add-On Code G0545 for Infectious Diseases Effective 1/1/2025 Definition of G0545 Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or [...]

Log In

Log In Table of Contents Log In Log into NGSConnex Log In Issues [Return to Top] Log In In order to login to NGSConnex, go to our website landing page. Read the standard disclaimer and click Accept to continue. [Return to [...]

Account Suspensions

Account Suspensions Table of Contents Account Suspensions Unsuspend Your Account Invalid Login Attempts [Return to Top] Account Suspensions If an NGSConnex account has not been used within the last 30 days, the account will be [...]

Caregiver Training Services

Caregiver Training Services Effective 1/1/2024, payment will be made when practitioners train caregivers to support patients with certain diseases or illnesses (e.g., dementia) in carrying out a treatment plan. A caregiver is defined as a [...]

Safeguard Your Finances: Know Your Provider Enrollment Revalidation

Safeguard Your Finances: Know Your Provider Enrollment Revalidation Attention: Provider Enrollment and Credentialing Teams Ensure you revalidate before your deadline to prevent a "Stay of Enrollment" or claim rejections, which could result in [...]

Navigating Medicare Home Health & Hospice Insights for Providers Podcast

Navigating Medicare Home Health & Hospice Insights for Providers Podcast Listen to our podcast on Spotify and Apple Podcasts!   We invite you to join our thoughtful conversations and helpful insights into the Home Health & [...]

Navigating Medicare Part A Insights for Providers Podcast

Navigating Medicare Part A Insights for Providers Podcast Listen to our podcast on Spotify and Apple Podcasts! Listen to our podcast, Navigating Medicare Part A Insights for Providers, now available on Spotify and Apple Podcasts! We will be [...]

Common Tobacco Withdrawal Symptoms

Common Tobacco Withdrawal Symptoms Trying to quit tobacco use feels different for each person, but almost everyone will have some symptoms of nicotine withdrawal. When stopped, the body and brain must get used to not having nicotine. This can [...]

Reopening versus Redetermination

Reopening versus Redetermination Table of contents Reopening versus Redetermination Reopening Telephone Reopening Unit Redeterminations [Return to Top] Reopening versus Redetermination Understanding your next steps are very [...]

Medicare Diabetes Prevention Program 2025 Changes

Medicare Diabetes Prevention Program 2025 Changes The MDPP Expanded Model is intended to prevent Medicare beneficiaries with an indication of prediabetes from developing diabetes. Prevention of diabetes among this high-risk group of Medicare [...]

Home Health Claims Returning to Provider RC 19963

HH claims are returning to provider in error with RC 19963. This impacts HH claims with NOA/processed dates in January 2022. NOAs are being purged after 24 months. Please keep in mind there are claims that edit correctly for this reason code. [...]

NGS Office of Congressional Affairs Welcome Letter

Dear Members of Congress and Staff: As your work continues in the 119th Congress, National Government Services, Inc. maintains its dedicated role in serving your district/state as a Medicare contractor for Original Medicare. We are your [...]

Screening Mammography

Preventive Services Guide Screening Mammography A mammogram is an X-ray of the breast. Screening mammograms are routinely administered to detect breast cancer in women who have no apparent symptoms. Coverage Guidelines and Frequency Limits [...]

PC-ACE Software Instructions, Resources and Guides

PC-ACE Software Instructions, Resources and Guides Creating a 276 Claim Status Request in PC-ACE and Importing and Reading the 277 Claim Status Report PC-ACE Software – For Professional Users: Importing and Reading the 999 & 277CA Files [...]

APPEALS: How would one submit a paper appeal?

APPEALS: Where can I find the regulations on Medicare appeals?

APPEALS: I received a remittance advice with the message “this care may be covered by another payer per coordination of benefits.” Is this an appealable claim?

APPEALS: How can I get status of my redetermination or reopening request?

APPEALS: Is there a time limit for filing an appeal?

APPEALS: We are a large group with many physician and nonphysician practitioners. When we submit claims for nonphysician practitioners working in different sub-specialties, we receive denials that state: D984: Coverage/program guidelines not met, N20: Service not payable with other service rendered on the same day.