Supplemental Medical Review Contractor

Targeted Probe and Educate

Confirm Eligibility to Enroll

Obtain an NPI

Obtain/Verify State License

Submit Enrollment Application

Electronic Funds Transfer

What to Expect After Submission

Register for EDI

Register for NGSConnex

When to Notify Medicare of Changes

Verify NPI

Obtain/Verify State License

Submit Enrollment Application

What to Expect After Submission

Electronic Funds Transfer

Change Existing Provider Enrollment Information

Hot Topics

Familiarize Yourself with Enrollment Revalidation

Verify NPI

Obtain/Verify State License

Submit Enrollment Application

What to Expect After Submission

Electronic Funds Transfer

Revalidating Your Enrollment

Deactivation, Suspension and Reactivation

Opt Out of Medicare

Enrollment Forms

Helpful Tips

00_NGSConnex News Template

NGSConnex Available Today Once you have used these new features, we would love to hear feedback about your experience. Click “Yes, I’ll give feedback” the next time the ForeSee survey pops up. Your feedback is a catalyst for change. [...]

Change Existing Provider Enrollment Information

Revalidating Your Enrollment

Deactivation, Suspension and Reactivation

Helpful Tips

Authorization and Accreditation

Submit Enrollment Application

Electronic Funds Transfer

What to Expect After Submission

NGSConnex

MEDICARE UNIVERSITY

Provider Enrollment, Chain, and Ownership System

Incorrect Billing of CPT 76942 with Prostate Biopsy CPT 55700 When 76872 Billed for Same Session

Incorrect Billing of CPT 76942 with Prostate Biopsy CPT 55700 When 76872 Billed for Same Session Although AMA Guidelines state it is appropriate to bill CPT codes 76942, 77002, 77012 or 77021 if imaging is performed with 55700, NCCI lists [...]

CPT Code 92229

CPT Code 92229 For CY 2021, Medicare began making payment for CPT code 92229 (Imaging of retina for detection or monitoring of disease; with point-of-care automated analysis with diagnostic report; unilateral or bilateral). In the CY 2021 [...]

Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis

Update: End Stage Renal Disease Claim Adjustments Needed Due to CWF Error in Date of First Dialysis As of 7/18/2023, CMS has identified that the CWF continues to have some inaccurate dates for the first date of dialysis. We will advise when [...]

Targeted Probe and Educate: Medical Review Topics

Targeted Probe and Educate: Medical Review Topics The Medical Review team has developed a comprehensive list of common denials found during Targeted Probe and Educate reviews along with resources to assist you in understanding how to avoid [...]

Activation of Validation Edits for Providers with Multiple Service Locations (MLN Matters Number: SE19007 Revised)

Activation of Validation Edits for Providers with Multiple Service Locations (MLN Matters Number: SE19007 Revised) Posted 7/20/2023

MLN Connects® Newsletter: July 20, 2023

MLN Connects® Newsletter: July 20, 2023 News Percutaneous Transluminal Angioplasty of Carotid Artery Concurrent with Stenting: Proposed National Coverage Determination Beta Amyloid Positron Emission Tomography in Dementia and [...]

Selecting the Submitter Type

Selecting the Submitter Type Each submitter type includes a description and the available tasks that can be completed for each. There are three submitter types:  Provider – The provider of service.  The Authorized or [...]

Completing the Registration Forms

Completing the Registration Forms  Complete all required fields marked with an asterisk or you will not be able to proceed with the submission of the form. The type of registration form and required information is going to vary depending [...]

EDI Gateway Self-Service Password Portal

EDI Gateway Self-Service Password Portal As an EDI Trading Partner, you will be able to use the EDI Gateway Self-Service Password Portal located on the EDI web page on our website. This provides a simple and secure web-based process for [...]

EDI Enrollment Process User Guide

Selecting Which System To Connect To

Selecting Which System To Connect To Select one objective based on the description provided and then click Next. Note: The options displayed will vary based on the submitter type selected.   

Submitting the Packet

Submitting the Packet After the enrollment packet is submitted, a confirmation message is displayed on the screen with the assigned Packet ID (PID) number. This has completed the submission process. You will be given the options to Print this [...]

Multi-Jurisdictional CAC Meeting Notice on Cervical Fusion

Multi-Jurisdictional CAC Meeting Notice on Cervical Fusion Information has been posted on our website in regards to multi-jurisdictional Contractor Advisory Committee Meeting regarding Cervical Fusion to be held on 8/16/2023. For more [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Appeals

Appeals State MAC Appeals Address Qualified Independent Contractor Address All federally qualified health centers National Government Services, Inc. Appeals Department P.O. Box 6474 Indianapolis, IN [...]

Submitter Type - Provider

Submitted Type – Provider  When Provider is selected as the submitter type the four objectives below are displayed.  Select one objective based on the description provided and then click Next. Outlined in the following sections [...]

Submitter Type - Billing Service

Submitter Type – Billing Service When Billing Service is selected as your submitter the three objectives below are displayed.  Select one objective based on the description provided and then click Next. Outlined in the following [...]

Selecting the Contractor Code

Selecting the Contractor Code Select the contract in which the provider of service is enrolled in the Medicare Program in the Contract Code field. Click the drop-down arrow to display the available contractor codes.  Select the [...]