U5181

Avoiding/Correcting This Error Ensure the usage of an appropriate certification or recertification date in accordance with occurrence code 27. Related Content Avoiding Reason Code U5181: Appropriate Use of Occurrence Code 27/Occurrence [...]

38050

Avoiding/Correcting This Error Check your remittance advice or the claims processing system for a previously submitted/processed claim before submitting any new billing.

37364

Avoiding/Correcting This Error There was an issue with NOAs incorrectly editing for U537F. Once the system was fixed, NOAs could be resubmitted and subsequently processed. NOAs submitted late due to this issue may have affected more than one [...]

38031

Avoiding/Correcting This Error Verify the ‘from’ and ‘through’ dates, provider number, revenue codes, HCPCS codes, and line item date of service on the bill. If the claim is truly a duplicate; no action is necessary. Providers should develop [...]

38032

Avoiding/Correcting This Error Providers should develop and implement a process to ensure that duplicate claims are not being submitted. If the claim is truly a duplicate, no action is necessary. If this is not a duplicate and the provider [...]

38054

Avoiding/Correcting This Error Verify the claim history to determine the period of care claim that is causing the overlap If there are services that should have been included on a processed/paid claim, you must submit an adjustment (3X7 [...]

38055

Avoiding/Correcting This Error Verify the claim history using the FFS/DDE Provider Online system, your remittance advice and/or the CWF to determine the episode claim that is causing the overlap If there are services that should have been [...]

38200

Avoiding/Correcting This Error This reason code may be applied when an NOA and period of care claim are submitted at the same time or when an NOA and one is already in the system. If the NOA and claim were submitted at the same time, and no [...]

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. Providers can see line details in NGSConnex and hover over the line item reason code(s) for [...]

39934

Avoiding/Correcting This Error You can find line level information by accessing MAP171D in the FISS/DDE Provider Online System: Hit <F2>/<PF2> once or <F11>/<PF11> twice from Claim Page 02 of the claim to access [...]

U5200

Avoiding/Correcting This Error Verify that the MBI on the claim is for the correct beneficiary. If the MBI is correct, verify the beneficiary’s entitlement information, correct, and resubmit if appropriate. If the MBI is incorrect, submit [...]

U5211

Avoiding/Correcting This Error Verify the MBI and dates of service. If appropriate, correct the information and submit a new claim or update returned claim. If the actual date of death was reported in error to the Social Security office, [...]

U5600

Avoiding/Correcting This Error Providers should develop and implement a process to ensure that duplicate claims are not being submitted. If the claim is truly a duplicate, no action is necessary If this is not a duplicate and the provider [...]

37364

Avoiding/Correcting This Error There was an issue with NOAs incorrectly editing for U537F. Once the system was fixed, NOAs could be resubmitted and subsequently processed. NOAs submitted late due to this issue may have affected more than one [...]

38055

Avoiding/Correcting This Error Verify the claim history using the FFS/DDE Provider Online system, your remittance advice and/or the CWF to determine the episode claim that is causing the overlap If there are services that should have been [...]

38200

Avoiding/Correcting This Error This reason code may be applied when an NOA and period of care claim are submitted at the same time or when an NOA and one is already in the system. If the NOA and claim were submitted at the same time, and no [...]

39934

Avoiding/Correcting This Error You can find line level information by accessing MAP171D in the FISS/DDE Provider Online System: Hit <F2>/<PF2> once or <F11>/<PF11> twice from Claim Page 02 of the claim to access [...]

Prepare and Submit a Medicare Secondary Payer Claim

Table of Contents Background Step 1: Determine If You Must Submit an MSP Claim Step 2: Prepare an MSP Claim MSP Billing Code Table Step 3: Check for a Matching MSP Record for the Beneficiary in the Common Working File Step [...]

Contractor Advisory Committee Meeting

Contractor Advisory Committee Meeting As part of the 21st Century Cures Act, contractors are mandated to base an LCD on robust evidence. Part of the process is to convene SMEs as necessary to review the literature and provide input that [...]

Multi-Jurisdictional Peripheral Nerve Blocks Contractor Advisory Committee Meeting on 2/3/2025

Multi-Jurisdictional Peripheral Nerve Blocks Contractor Advisory Committee Meeting on 2/3/2025 The Multi-Jurisdictional Peripheral Nerve Blocks Contractor Advisory Committee Meeting is scheduled for 2/3/2025 from 2:00–4:00 p.m. ET, via [...]

MLN Connects® Newsletter: January 16, 2025

MLN Connects® Newsletter: January 16, 2025 News Resources & Flexibilities to Assist with the Public Health Emergency in California CMS Moves Closer to Accountable Care Goals with 2025 Accountable Care Organization Initiatives [...]

FQHC and RHC Claims RTP for W7072

Between 10/1/2024 and 12/31/2024, RHC (TOB 071X) and FQHC (TOB 077X) claims that contained HCPCS code 93010 were RTP in error with reason code W7072.

Letters Regarding Deactivation of Enrollment Due to Infrequent Billing - Correction of Fax Number

Letters Regarding Deactivation of Enrollment Due to Infrequent Billing - Correction of Fax Number If you received a letter from National Government Services dated 1/10/2025 regarding a deactivation of your enrollment due to infrequent billing, [...]

2024 Calendar Year 1099 Form Information

2024 Calendar Year 1099 Form Information National Government Services will mail all 1099 Forms for calendar year 2024 no later than 1/31/2025. Medicare providers and beneficiaries, who are serviced by NGS regardless of their location, will [...]

Improving Customer Experience

Improving Customer Experience We are committed to improving your experience. Please watch this two-minute video that explains how each day we review comments from providers who submit surveys to let us know what is working well and how we can [...]

Connecticut ASC Fee Schedule Listing

Connecticut ASC Fee Schedule Listing  CMS is using CBSA planning areas/numbers instead of counties for fee schedule listings for ASCs in the state of Connecticut.  CBSAs refer collectively to metropolitan statistical areas and [...]

Fee Schedule Assistance

Fee Schedule Assistance Connecticut Illinois Locality/Area and County Information Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Locality/Area and County Information New York Locality/Area and County Information Locate and [...]

Jurisdiction K Part B Top Claim Errors Are Updated

Jurisdiction K Part B Top Claim Errors Are Updated Did you know we publish the top claim errors on our website? This resources provides detailed information including: the error reason code; a description of the error; the error type; [...]

What are the administration codes for the pneumococcal vaccine?

Can a mass immunizer combine pneumococcal with other vaccines on one roster bill?

Does Medicare pay for counseling and education of the pneumococcal vaccine?

If I administer two different vaccinations during the same visit, e.g., influenza and pneumococcal, can I bill for two separate administrations?

Is an order required to administer the pneumococcal vaccine?

Is the pneumococcal vaccine subject to coinsurance and deductible?

What are the allowance limits for the cost of the pneumococcal vaccine?

What is the frequency requirement for the pneumococcal vaccine?

Frequently Asked Questions Have Been Reviewed and Updated

Frequently Asked Questions Have Been Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Please take time to review these FAQs for answers to [...]

Medicare Telehealth Changes for 2024/2025

Medicare Telehealth Changes for 2024/2025 Table of Contents Major Medicare Telehealth Flexibilities Not Affected by the End of the PHE Reporting Home Address Direct Supervision Requirements Teaching Physicians Remote Evaluations, [...]

Colorectal Cancer Screening

Preventive Services Guide Colorectal Cancer Screening Screenings are performed to diagnose colorectal cancer or to determine a beneficiary’s risk for developing colorectal cancer. Colorectal cancer screening may consist of several different [...]

Top Claim Errors Reviewed and Updated

Top Claim Errors Reviewed and Updated Using data analysis, we review and update the Top Claim Errors on a quarterly basis. View Top Claim Errors to quickly identify the information you need to avoid processing delays and get [...]