FISS/DDE

Fiscal Intermediary Standard System/Direct Data Entry DDE is a process that allows remote users online connectivity to the FISS, or mainframe, used by National Government Services to process Medicare claims. FISS/DDE connectivity will allow [...]

FISS/DDE

Fiscal Intermediary Standard System/Direct Data Entry DDE is a process that allows remote users online connectivity to the FISS, or mainframe, used by National Government Services to process Medicare claims. FISS/DDE connectivity will allow [...]

FISS/DDE

Fiscal Intermediary Standard System/Direct Data Entry DDE is a process that allows remote users online connectivity to the FISS, or mainframe, used by National Government Services to process Medicare claims. FISS/DDE connectivity will allow [...]

Congressional Offices

The Congressional Affairs Outreach and Education team at National Government Services, Inc. is committed to ensuring that congressional offices receive a timely response to your inquiries and helpful Medicare information. For your convenience, [...]

Appeals

Appeals Reopenings Telephone Reopening Unit Jurisdiction 6 Telephone Reopening Unit Contact Number Hours of Service Illinois 877-867-3418, Press 1 8:00 a.m.–4:00 p.m. CT Closed for training on the [...]

J6 Part B Applying for an Extended Repayment Schedule

Applying for an Extended Repayment Schedule

DRG (Pricer/Grouper) (11)

Chapter IV: Inquiries Submenu (01) DRG (Pricer/Grouper) (11) Purpose This option will be used by the provider to research PPS information as it pertains to an inpatient stay. To access the DRG (Pricer/Grouper) option from the FISS Online [...]

RSNAT Pre-Pay Review

RSNAT Pre-Pay Review The RSNAT PA program has two components, PAR or prepayment review, which suppliers are able to use their discretion on the path that best suits their workflow. If a RSNAT supplier chooses to forgo the PA process for [...]

Billing and Coding Article Update for August 2023

Billing and Coding Article Update for August 2023 Billing and Coding: Non-Invasive Vascular Studies (A56758) Effective 8/31/2023, the following ICD-10-CM codes were added to the "ICD-10-CM Codes That Support Medical Necessity" section (Group [...]

MLN Connects® Newsletter: August 24, 2023

MLN Connects® Newsletter: August 24, 2023 News Seasonal Flu Vaccine Pricing for 2023–2024 Season Expanded Home Health Value-Based Purchasing Model: July 2023 Interim Performance Reports, Post-Event Materials, & Comment on CY 2024 [...]

Unprocessable Claim Rejections and Corrections

Unprocessable Claim Rejections and Corrections Assigned and nonassigned services are considered unprocessable when incomplete or invalid information is detected in our claims processing system. Unprocessable claim is described in the CMS IOM [...]

Medicare Beneficiary Eligibility Checklist

Tip Sheet #1

National Government Services Office of Congressional Affairs Protocol: Tip Sheet #1 Medicare is changing and we live in a MAC world and this protocol explains the process to help you submit your Medicare constituent inquiries. Today, [...]

Multi-Factor Authentication

Multi-Factor Authentication Multi-factor authentication (MFA) is a second layer of security required by CMS to have online access to protected health information. The MFA screen will display every time you log in to NGSConnex. Each day [...]

View Remittance

View Remittance If you receive SPRs you will not be able to view remittance statements in NGSConnex. If you are signed up to receive an 835 ERAs or you have elected to view remittance statements through NGSConnex, you may view and print or [...]

Change Your Password

Change Your Password Select the Manage Account button on the NGSConnex home page. Select User Profile. You must change your NGSConnex password at least once every 60 days. This is a CMS security requirement to have online access to [...]

Processing Drivers and System Claim Paths

Chapter I: Online System Terminology   Processing Drivers and System Claim Paths Purpose Claims that are filed through the FISS DDE Provider Online System follow a prescribed route referred to as a system claim path. Claim paths [...]

Claim Status and Location Codes

Chapter I: Online System Terminology Claim Status and Location Codes Purpose The purpose of the status and location is to route claims through FISS. The status describes the general condition of the claim (i.e., whether paid, denied, [...]

Main Menu

Chapter II: Online Menu Functions Overview FISS/DDE Main Menu Purpose The FISS/DDE MAIN MENU offers the following four submenu options: 01 – Inquiries 02 – Claims/Attachments 03 – Claims Correction 04 – Online Reports View [...]

Inquiries Submenu

Chapter II: Online Menu Functions Overview Inquiries Submenu Purpose The INQUIRIES submenu allows providers to perform research through various file options, such as the following: Beneficiary/CWF information Claim status DRG [...]

HCPCS Codes (14)

Chapter IV: Inquiries Submenu (01) HCPCS Codes (14) Purpose The purpose of the HCPC CODES option is to provide access to details related to the HCPCS codes available to be reported on a claim. HCPCS codes are five-digit alphanumeric [...]

DX/Proc Codes ICD-9 (15)

Chapter IV: Inquiries Submenu (01) DX/Proc Codes ICD-9 (15) Purpose The purpose of the DX/PROC CODES ICD-9 option is to provide a reference of ICD-9-CM code(s) used to identify a specific or various diagnosis codes or inpatient surgical [...]

Adjustment Reason Codes (16)

Chapter IV: Inquiries Submenu (01) Adjustment Reason Codes (16) Purpose An adjustment reason code is a two-digit alphanumeric code reported on a claim adjustment to identify the specific reason the claim is being adjusted. This option [...]

Reason Codes (17)

Chapter IV: Inquiries Submenu (01) Reason Codes (17) Purpose FISS reason codes are five-digit alphanumeric codes that indicate the outcome of claim editing and processing. The REASON CODE option provides details to indicate why the claim [...]

Claim Count Summary (56)

Chapter IV: Inquiries Submenu (01) Claim Count Summary (56) Purpose The CLAIM COUNT SUMMARY option provides a review of the total claim count and total dollar amount for claims pending in a specific location. This information is updated in [...]

Invoice Number/DCN Translator (88)

Chapter IV: Inquiries Submenu (01) Invoice Number/DCN Translator (88) Purpose The purpose of the Invoice Number/DCN Translator screen is to allow the provider to identify a claim’s Invoice Number when the DCN is known. This option also [...]

Community Mental Health Centers Services Payment Totals (1C)

Chapter IV: Inquiries Submenu (01) Community Mental Health Centers Services Payment Totals (1C) Purpose The purpose of the CMHC Payment Totals screen (MAP1D61) is to display the CMHC payment and outlier totals for current year and one [...]

Provider Practice Address Query (1D)

Chapter IV: Inquiries Submenu (01) Provider Practice Address Query (1D) Purpose The purpose of the Provider Practice Address Query screen is to display the additional practice addresses for a facility; this includes off-campus, outpatient, [...]

New HCPCS Screen (1E)

Chapter IV: Inquiries Submenu (01) New HCPCS Screen (1E) Purpose The purpose of the New HCPCS Screen (1E) is to provide information related to HCPCS pricing and allowable revenue codes related to HCPCS. HCPCS codes are five-digit [...]

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier

New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier Effective 5/16/2023, CMS implemented a new FISS consistency edit to validate the attending provider NPI. The attending provider [...]

Part B Mass Adjustments Resulting in Overpayments

Part B Mass Adjustments Resulting in Overpayments In May 2023, the OIG released the final report titled “Medicare Paid Millions More for Physician Services at Higher Nonfacility Rates Rather Than at Lower Facility Rates While Enrollees Were [...]

October 2023 Release "Dark Days" for the Common Working File Hosts

October 2023 Release "Dark Days" for the Common Working File Hosts For the upcoming October 2023 Release: For Production, CWF will be observing the Gray Day on Thursday, 9/28/2023 and Dark Days starting Friday, 9/29/2023 through Sunday, [...]

Opioid Use Disorder (OUD) Demo 99 (1F)

Chapter IV: Inquiries Submenu (01) Opioid Use Disorder (OUD) Demo 99 (1F) Purpose The purpose of the OUD DEMO option is to provide claim information such as CAP (maximum number of claims that can be billed by the provider with HCPCS G2172), [...]

Roster Bill Entry (87)

Chapter V: Claims/Attachments Submenu (02) Roster Bill Entry (87) Purpose Roster billing is a streamlined process for submitting Medicare claims for a large group of beneficiaries for influenza virus or pneumococcal vaccinations. Up [...]

Summary of Reports (R1)

Chapter VII: Online Reports View Submenu (04) Summary of Reports (R1) Purpose This option allows the provider to review a list of all reports currently available to view online. Additionally, the provider will be able to view the data [...]

FISS Reason Code/Claim Driver Overview

Resources FISS Reason Code/Claim Driver Overview The following chart outlines the association between the FISS claim drivers and the reason code ranges. Driver # Driver Definition Reason Code Range(s) 04 UB-04 [...]

How to Correct a Return to Provider Claim

Resources How to Correct a Return to Provider Claim To correct a RTP claim on the FISS/DDE Provider Online System, follow these steps: Step Action 1 Select the CLAIMS CORRECTION (03) submenu from the MAIN MENU [...]

New and Improved EDI Enrollment Process

New and Improved EDI Enrollment Process Our new online EDI Enrollment Process is available. This new process includes real time verification of data entered into many of the fields, which improves accuracy, reduces the time needed to complete [...]

RC 34963 – Provider Enrollment Issue

An issue in the PECOS is causing some Part A claims to RTP in error with RC 34963.

Resetting Your EDI Password

Resetting Your EDI Password EDI passwords have to be regularly changed or reset to maintain data security. You should note that passwords expire every 60 days and can be changed or reset prior to expiration. Follow these steps to reset your [...]

MLN Connects® Newsletter: August 31, 2023

MLN Connects® Newsletter: August 31, 2023 News HHS Selects the First Drugs for Medicare Drug Price Negotiation Medicare Shared Savings Program Saves Medicare More Than $1.8 Billion in 2022 and Continues to Deliver High-quality Care CMS [...]

Revised: Two Interactive Voice Response System Features Ending 9/30/2023

Revised: Two Interactive Voice Response System Features Ending 9/30/2023 As of 10/1/2023, the following functions will no longer be available on our IVR; however, we are providing you with alternative options to obtain the same information. [...]

Provider Enrollment: Resumed Revalidation Activities

Provider Enrollment: Resumed Revalidation Activities Attention: Provider Enrollment and Credentialing Departments Activities have resumed with revalidation due dates starting with 1/31/2022. Don’t wait to revalidate if CMS assigned a current [...]

End of the Public Health Emergency: Over The Counter COVID-19 Test Kits

End of the Public Health Emergency: Over The Counter COVID-19 Test Kits With the end of the PHE on 5/11/ 2023, coverage for COVID-19 testing for Americans will change. Medicare beneficiaries who are enrolled in Medicare Part B will continue to [...]

New Service Added to the Hospital Outpatient Department Prior Authorization Program - Facet Joint Interventions

New Service Added to the Hospital Outpatient Department Prior Authorization Program - Facet Joint Interventions As a reminder, effective for dates of service rendered on or after 7/1/2023, facet joint interventions are added to the OPD [...]

Registration is Open for the Part B Claim Submission Learning Day

Registration is Open for the Part B Claim Submission Learning Day Join us on Tuesday, 5/9/2023 for our Part B Claim Submission Learning Day! Our Part B POE Team is hosting a full day of educational webinars focused on submitting claims [...]

Prior Authorization Outpatient Department Rejections Alert

Prior Authorization Outpatient Department Rejections Alert National Government Services has seen a significant increase in rejections due to invalid information provided on PAR cover sheets.   Please see the following for top reasons for [...]

MLN Connects® Newsletter: June 8, 2023

MLN Connects® Newsletter: June 8, 2023 News CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in the Territory of Guam Due to Recent Typhoon CMS Roundup (June 2, 2023) Gender-Specific Services: Billing [...]

MLN Connects® Newsletter: June 1, 2023

MLN Connects® Newsletter: June 1, 2023 News CMS Announces Plan to Ensure Availability of New Alzheimer’s Drugs COVID-19 Health Care Staff Vaccination Final Rule Medicare Secondary Payer Accident-Related Diagnosis Codes: How to Get Paid [...]

Local Coverage Determination Open Meeting Announcement

Local Coverage Determination Open Meeting Announcement Jurisdiction 6/Jurisdiction K Part A/Part B MAC To ensure the development of LCDs occurs through a public and open process, we are soliciting scientific evidence and other [...]

MLN Connects® Newsletter: March 23, 2023

MLN Connects® Newsletter: March 23, 2023 News Additional Residency Positions: Apply by March 31 Laboratory Testing Urinalysis: Comparative Billing Report in March Long-Term Care Hospital Provider Preview Reports: Review by April 14 [...]

Appealing a Denied Claim

Appealing a Denied Claim At times, providers submit a claim that ends up being denied; the denial may include appeal rights. Providers can appeal all of their overpayment claims on one request for redetermination, which is the first level of [...]

MLN Connects® Newsletter: March 16, 2023

MLN Connects® Newsletter: March 16, 2023 News HHS Releases Initial Guidance for Historic Medicare Drug Price Negotiation Program for Price Applicability Year 2026 Quality Payment Program: 2021 Care Compare Performance Information [...]

Physicians/Practitioners! Are You Ordering Oxygen for Your Patients?

Physicians/Practitioners! Are You Ordering Oxygen for Your Patients? This is your opportunity to hear directly from the Medicare contractors regarding documentation required for coverage criteria to be met and allow your patients to receive [...]

Attention Illinois Medicare Providers: Stepping Into a New Era with Opioids - CDC Best Practices

Attention Illinois Medicare Providers: Stepping Into a New Era with Opioids - CDC Best Practices Presented by Telligen QIN-QIO As part of our continuing work together, National Government Services would like to make our providers aware of a [...]

MLN Connects® Newsletter: February 23, 2023

MLN Connects® Newsletter: February 23, 2023     News Hospital Price Transparency: Progress and Commitment to Achieving Its Potential Home Infusion Therapy Services Monitoring Report Immunosuppressive Drugs: Comparative [...]

Changing Diagnosis Codes on Previously Processed Claims

Changing Diagnosis Codes on Previously Processed Claims National Government Services, is frequently asked about diagnosis code changes on claims that have already been processed. We hope this notification helps for a better understanding. [...]

MLN Connects® Newsletter: February 9, 2023

MLN Connects® Newsletter: February 9, 2023     News DMEPOS: Get Benefit Category Determinations Nurse Practitioners and Clinical Nurse Specialists: Update to List of National Certifying Bodies Help Address Heart Health [...]

2022 Calendar Year 1099 Form Information

2022 Calendar Year 1099 Form Information Medicare providers and beneficiaries, who are serviced by National Government Services, regardless of their location, will receive a single Part A and Part B combined Form 1099 from NGS for [...]