2025 Gapfill Request Reminder

2025 Gapfill Request Reminder National Government Services, the MAC for JK and J6, is in receipt of the new laboratory test codes identified by CMS to be gap-fill priced for 2025. Please access the complete information on our website: 2025 [...]

Medicare Advantage Information For Part A and Part B Not Offered on the IVR Beginning 3/14/2025

Medicare Advantage Information For Part A and Part B Not Offered on the IVR Beginning 3/14/2025 Effective the evening of 3/14/2025, the Medicare IVR system will no longer provide information regarding the Medicare Advantage:  plan [...]

Medicare Diabetes Prevention Program

Medicare Diabetes Prevention Program Table of Contents Background What is the Medicare Diabetes Prevention Program? Overview of MDPP What is Covered Through the Model? What Does this Mean for Beneficiaries? What Does this Mean [...]

Membership Rosters

Membership Rosters Jurisdiction 6 and Jurisdiction K Home Health POE Advisory Group Roster Member Provider/Institution State Abreau-Costa, Maria Mozaic Senior Life Connecticut Adam, Sherie [...]

Diabetes Self-Management Training

Preventive Services Guide Diabetes Self-Management Training According to the Centers for Disease Control and Prevention, approximately 38.4 million Americans have diabetes and 27.2 million people aged 65 years or older (48.8%) have been [...]

Common Questions for Diabetes Self-Management Training and Medical Nutrition Therapy

Common Questions for Diabetes Self-Management Training and Medical Nutrition Therapy Table of Contents Diabetes Programs Billing for Services DSMT and MNT Telehealth Services Related Content [Return to Top] Diabetes Programs [...]

Meeting Schedules

Meeting Schedule Part A POE AG Meetings for Jurisdiction 6 and Jurisdiction K J6: Illinois, Minnesota, Wisconsin and Federally-Qualified Health Centers in all states JK: Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island [...]

The National Correct Coding Initiative

The National Correct Coding Initiative The purpose of the NCCI PTP edits is to prevent improper payment when incorrect code combinations are reported. The NCCI contains one table of edits for physicians/practitioners and one table of edits for [...]

Expanded Home Health Value-Based Purchasing Model

Expanded Home Health Value-Based Purchasing Model Overview The HHVBP Model is an initiative by CMS aimed at improving the quality of care provided by home health agencies while also fostering greater efficiency. It builds on the original [...]

Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating

Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating Did you know that tobacco cessation counseling is a covered Medicare service? Brief tobacco counseling provides substantial health benefits while producing cost savings. [...]

HCPCS 90658 Claim Hold

Claim hold for CPT 90658 (influenza vaccine)

FQHC Claim Hold Effective DOS 1/1/2025

CMS has issued claim hold instructions to all MACs, due to release and testing of a new FQHC pricer.

[RESOLVED] Medicare Claim Process System Experiencing Outages

[RESOLVED] Medicare Claim Process System Experiencing Outages We were experiencing outages with our IVR and NGSConnex claim status functionality. Technical support was engaged and the issue is now resolved. The IVR and NGSConnex claim status [...]

How To Get Started - Five Easy Steps

How To Get Started – Five Easy Steps Contact your vendor, clearinghouse or billing service to ensure they support the electronic attachment program which includes the following: 6020 version of the 277RFI transaction; HL7 CDA R2 [...]

MLN Connects® Newsletter: February 14, 2025

MLN Connects® Newsletter: February 14, 2025 News Complex Non-Chemotherapeutic Drug Administration: Determining Payment for Services Claims, Pricers, & Codes Ambulance Fee Schedule: CY 2025 Inflation Factor Integrated Outpatient [...]

PA Exemption Tool Top

Prior Authorization Exemption Status Inquiry Tool This is a self-service tool to allow both hospital or physician office staff responsible for submitting PARs, to check the exempt status of the HOPD. This tool will only recognize the [...]

Reminder: New Medicare Part B Redetermination Notice Initiative

Reminder: New Medicare Part B Redetermination Notice Initiative As we’ve communicated, National Government Services is transitioning to electronic notifications for Part B Medicare Redetermination decisions when a Medicare Part B [...]

Collaborative Urological Supplies Webinar Coming 3/27/2025

Collaborative Urological Supplies Webinar Coming 3/27/2025 This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s criteria necessary for the coverage of urological supplies. Representatives from all four [...]

Requirements of Medicare Opt-Out Affidavit Agreement

Requirements of Medicare Opt-Out Affidavit Agreement Amendment 4507 of the Balanced Budget Act of 1997 permits a physician or practitioner to “opt out” of Medicare and enter into private contracts with Medicare beneficiaries if specific [...]

Jurisdiction 6 State Licensing and Certification Websites

State Licensing and Certification Websites The following list contains helpful links to websites of some organizations within J6 that can be used to verify your status. Table of Contents Illinois Minnesota Wisconsin National [...]

Local Coverage Determination Open Meeting Announcement

Local Coverage Determination Open Meeting Announcement Table of Contents Jurisdiction 6/Jurisdiction K Part A/Part B MAC Requests to Present Registered Presenters (Slide Presentations Only) Observers Comments on Proposed LCDs [...]

Prepare and Submit an MSP Conditional Claim

Table of Contents Background Step 1: Determine if You Can Submit a Conditional Claim Step 2: Prepare a Conditional Claim Conditional Billing Code Table Step 3: Check for a Matching MSP Record for the Beneficiary in the Common [...]

Accreditation of Advanced Diagnostic Imaging and FDA Mammography Equipment

Reminder, if a hospital, clinic/group or Independent Diagnostic Treatment Facility has ADI screening equipment, certification from a designated ADI accrediting organization needs to be implemented or updated on the Medicare enrollment. The [...]

Audit and Reimbursement

Audit and Reimbursement Cost Report Filing State/Region Contact Information Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont JK_Cost_Report_Filing@anthem.com FQHC (All), [...]

Audit and Reimbursement

Audit and Reimbursement Cost Report Filing State/Region Contact Information Jurisdiction 6 J6_cost_report_filing@anthem.com Jurisdiction K JK_cost_report_filing@anthem.com Provider Statistical [...]

Standard Companion Guides

Standard Companion Guides Standard Companion Guide Trading Partner Information (275) Standard Companion Guide Trading Partner Information (277) Standard Companion Guide Trading Partner Information (278/275) Standard Companion Guide Health [...]

Local Coverage Determination Open Meeting

Local Coverage Determination Open Meeting National Government Services is hosting a Local Coverage Determination Open Meeting on 3/13/2025. Details are available by accessing the Local Coverage Determination Open Meeting Announcement. [...]

NCCI Lookup Tool

Inactivity

Inactivity Medicare will routinely deactivate the billing privileges of those providers who fail to bill the Medicare Program for six consecutive months or more. Each billing account is considered separately for the deactivation criteria. This [...]

Do Not Forward “DNF”

Do Not Forward “DNF” With implementation of the DNF initiative, contractors were required to use “return service requested” envelopes for hard copy RAs, hard-copy checks and returned EFT payments. If you are a provider that receives hard [...]

Site Visit Failure

Site Visit Failure CMS reserves the right, when deemed necessary, to perform onsite review of a provider or supplier to verify that the enrollment information submitted to CMS or its agents is accurate and to determine compliance with Medicare [...]

Failure to Report Address Changes

Failure to Report Address Changes Providers who fail to report an address change will result in suspension of Medicare payment.   All Medicare providers are responsible for providing their Medicare contractor with their current and [...]

Failure to Report a Change in Bank Account Information

Failure to Report a Change in Bank Account Information Providers who fail to report a change in bank account information will result in suspension of Medicare payment and termination of Medicare billing privileges. All changes initiated by [...]

Revocation

Revocation CMS may revoke a currently enrolled provider or supplier's Medicare billing privileges and any corresponding provider or supplier agreement for the following reasons: Abuse of billing privileges Failure to document or provide [...]

Failure to Report a Critical Change

Failure to Report a Critical Change Providers and suppliers enrolled in Medicare are required to ensure strict compliance with Medicare regulations by submitting updates and changes to enrollment information in accordance with specified [...]

Failure to Complete Revalidation

Failure to Complete Revalidation Avoid claims being rejected or termination of Medicare billing privileges by responding: by the revalidation due date timely to additional information requested Related Content Medicare Revalidation [...]

Global Period Services - HCPCS Code G0559

Global Period Services - HCPCS Code G0559 As of 1/1/2025, CMS has implemented HCPCS Code G0559 to capture work performed by a provider other than the performing surgeon during the global period associated with most surgical procedures. The [...]

Jurisdiction K State Licensing and Certification Websites

State Licensing and Certification Websites The following list contains helpful links to websites of some organizations within JK that can be used to verify your status. Table of Contents Connecticut Maine Massachusetts New [...]

Deactivation of Billing Privileges/Suspension of Payment

Reasons for Deactivation of Medicare Billing Privileges/Suspension of Payment (not all inclusive) Inactivity Failure to complete revalidation within required time frame Unreported provider address and/or bank information Inactivity [...]

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