What Documents are Needed

What Documents are NeededYou are required to submit all necessary medical documentation to support the services billed on your claim as part of your participation agreement; you must submit a complete medical record when requesting an appeal. [...]

Comprehensive Error Rate Testing Program

Medical Policy Contact Information

Medical Policy Contact Information

Medical Policy Contact Information

Medical Policy Contact Information

Dental Codes Billed As Principal Diagnosis Code Cause Claim Rejections

Claims Submitted With Dental Codes As Principal Diagnosis Will RejectOn 1/3/2021, EDI added a new edit to the EDI Front-End. If an 837I claim contains principal diagnosis code 2300 HI with qualifier ABK (principal diagnosis) that is a dental [...]

You Asked, We Listened, We Delivered: Redesigned Events Page Live

You Asked, We Listened, We Delivered: Redesigned Events Page Live We’re always looking for and appreciate feedback from our providers. Your ideas and recommendations help drive improvements to our website. Providers suggested that we display [...]

The Change Healthcare/Optum Payment Disruption (CHOPD) CMS Fact Sheet Now Available

The Change Healthcare/Optum Payment Disruption (CHOPD) CMS Fact Sheet Now Available CMS issued the Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated Payments to Part A Providers and Advance Payments to Part B Suppliers Fact Sheet [...]

Advance and Accelerated Payment Program Available for Providers Impacted by the Change Healthcare/Optum Payment Disruption

Advance and Accelerated Payment Program Available for Providers Impacted by the Change Healthcare/Optum Payment Disruption Part A and Part B Providers experiencing cash flow problems related to Change Healthcare/Optum Payment Disruption [...]

Proper Medicare Part B Claim Submissions – Completion and Regulation for the CMS-1500 Paper Claim Form Due to the Change Healthcare Security Incident

Proper Medicare Part B Claim Submissions – Completion and Regulation for the CMS-1500 Paper Claim Form Due to the Change Healthcare Security Incident Health care professionals and suppliers play a vital role in protecting the integrity of the [...]

Privacy Notice

Privacy Notice National Government Services, Inc. (NGS) contracts with the Centers for Medicare & Medicaid Services (CMS) and is a CMS contractor under the authority granted in Sections 1842, 1862(b) and 1874 of Title XVIII of the Social [...]

Reminder: Medicare Part A Claim Submissions Due to the Change Healthcare Security Incident

Reminder: Medicare Part A Claim Submissions Due to the Change Healthcare Security Incident Medicare Part A providers can use the FISS DDE for Part A claim entry. This option is free, and the provider may already use FISS DDE. Note: FISS DDE [...]

MLN Connects® Newsletter: March 14, 2024

MLN Connects® Newsletter: March 14, 2024 News CMS Roundup (Mar 8, 2024) Marriage and Family Therapists & Mental Health Counselors: Updated Enrollment FAQs Skilled Nursing Facilities: Billing Medicare for Respiratory Vaccines [...]

Nonphysician Practitioners-Reducing Costly Appeals; Increase Provider Revenue

Nonphysician Practitioners-Reducing Costly Appeals; Increase Provider Revenue National Government Services is committed to reducing the provider burden associated with Medicare claim denials and appeals. A significant segment of denials and [...]

Important Reminder: Change Healthcare Security Incident

Important Reminder: Change Healthcare Security Incident This is an important reminder related to the Change Healthcare Security Incident and the efforts of the CMS and National Government Services. Change Healthcare is a clearinghouse vendor [...]

Check Appeal History

Check Appeal History Table of Contents Check Appeal History Attaching Additional Supporting Documentation Attachments Submit [Return to Top] Check Appeal History Click the Appeals button from the NGSConnex homepage. [...]

Initiate a General Inquiry

Initiate a General Inquiry Table of Contents Initiate a General Inquiry Step 1: Provider Details Step 2: Inquiry Information Step 3: Attachments [Return to Top] Initiate a General Inquiry Click the Inquiries button from [...]

Initiate a Prior Authorization Request

Initiate a Prior Authorization Request Table of Contents Initiate a Prior Authorization Request Request Details Requestor’s Information Certifying Physician Information Attachments [Return to Top] Initiate a Prior [...]

Medicare Part B Drug Coverage

Medicare Part B Drug Coverage Medicare Part B may provide coverage for medically necessary drugs/biologicals that are furnished “incident to” a physician’s service. This coverage does not apply to drugs that are usually [...]

LCD and Article Updates for March/April 2024

LCD and Article Updates for March/April 2024 Local Coverage Determinations Fluid Jet System Treatment for LUTS/BPH (L38367) The age limitation of >80 years of age has been removed, effective for services rendered on or after 4/1/2024. [...]

Attention! New CMS-588 Electronic Funds Transfer Authorization Agreement (11/23) Version

Attention! New CMS-588 Electronic Funds Transfer Authorization Agreement (11/23) Version Effective 4/30/2024 the MACs may only accept the CMS-588 EFT (11/23) version, the outdated form will be returned. NOTE: An electronic application [...]

Understanding the Medicare Summary Notice and Options

Understanding the Medicare Summary Notice and Options If you get a Medicare-covered service, you’ll get an MSN in the mail every three months. The notice shows all your services that your Medicare provider of service billed to Medicare during [...]

Inquiry Reference Numbers Are Now Available on the IVR

Inquiry Reference Numbers Are Now Available on the IVR You can now get an inquiry reference number through the IVR. Once the caller makes a selection from the main menu, the IVR will ask, "Would you like an inquiry reference ID?" This will [...]

Attention Electronic Billers

Attention Electronic Billers National Government Services has experienced issues with electronic files downloaded by some of our trading partners (those who receive electronic files directly from NGS). This was not a widespread issue and only [...]

Compound Drugs

Compound Drugs If there is not a HCPCS code for the compound drug you are billing, then it is appropriate to bill J7999 ‒ Compounded Drug, Not Otherwise Classified. This applies to both pump and nonpump compound drugs. The name, dose and [...]

Unlisted Codes for Drugs and Biologicals (J3490, J3590 and J9999)

Unlisted Codes for Drugs and Biologicals (J3490, J3590 and J9999) An unlisted code should only be used when no other code adequately describes the service. They are commonly used when the drug/biological does not have a specific HCPCS code, [...]

Prolonged Drug and Biological Infusions Using an External Pump

Prolonged Drug and Biological Infusions Using an External Pump In some situations, a hospital outpatient department or physician office may purchase a drug for a medically reasonable and necessary prolonged drug infusion, begin the drug [...]

Chemotherapy General Infusion Information

Chemotherapy General Infusion Information There are CPT codes for several different types of infusions and injections for drugs and biologicals. These include codes for chemotherapy infusions and injections, therapeutic, prophylactic and [...]

Discarded Drugs/Wastage and JW, JZ Modifier

Discarded Drugs/Wastage and JW, JZ Modifier Medicare may pay for discarded drugs or wasted drugs and biologicals when: The provider/supplier must discard the remainder of a single-dose container after administering a dose or quantity to a [...]

Radiopharmaceutical Reimbursement

FQHC PPS Calculator

FQHC PPS Calculator   1/1/2024-12/31/2024 2023 2022 2021 2020 2019 Updated 3/26/2024

Patient-Supplied or Free-of-Charge Drugs

Patient-Supplied or Free-of-Charge Drugs When a patient purchases a drug and the physician administers it, the cost of the drug is not covered because it does not represent a cost to the physician. However, the administration of the drug is a [...]

Medicare Part B General Billing

Medicare Part B General Billing Claims for drugs and biologicals are mandatory assignment. Claims submitted as nonassigned will be converted to adjudicate as assigned. When billing drugs or biologicals, the drug name, dosage and invoice price [...]

Copy Claim Entry

Copy Claim Entry Table of Contents Copy Claim Entry Claim Lines Information – Add, Edit or Delete Ready to Submit Claim [Return to Top] Copy Claim Entry Part B providers who have a completed EDI enrollment form on file can submit [...]

Check Status of Prior Authorization Requests

Check Status of Prior Authorization Requests Table of Contents Check Status of Prior Authorization Requests View the Prior Authorization Submission Attachments [Return to Top] Check Status of Prior Authorization Requests You will [...]

View Financial Claim Number Information

View Financial Claim Number Information Table of Contents View Financial Claim Number Information Financial Claim Number Patient Search [Return to Top] View Financial Claim Number Information The FCN can be found on the Medicare [...]

Coding for Sinuva™ Claims

Coding for Sinuva™ Claims This notice is a coding instruction, and not an indication of coverage. FDA labels should be consulted for indications and usage. Coding updated effective 4/1/2021: Claims submitted to National Government Services [...]

Dermal Injections for Treatment of Facial Lipodystrophy Syndrome

Dermal Injections for Treatment of Facial Lipodystrophy Syndrome Table of Contents Dermal Injections for Treatment of Facial Lipodystrophy Syndrome Billing Guidelines Claim Completion Instructions Wastage Claim Completion Instructions [...]

Factor VIII Billing

Factor VIII Billing National Government Services has received questions on the proper billing for Factor VIII drugs. This article outlines appropriate billing for these services. If the submitted amount does not exceed $99,999.99, bill the [...]

Proper Billing for LEQVIO® HCPCS Code J1306

Proper Billing for LEQVIO® HCPCS Code J1306 Table of Contents Proper Billing for LEQVIO® HCPCS Code J1306 Claim Completion Requirements Drug Wastage Related Content [Return to Top] Proper Billing for LEQVIO® HCPCS Code J1306 [...]

Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview

Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview Table of Contents Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview Drugs and Dosage Conditions Requiring Prior [...]

Account Suspensions

Account Suspensions Table of Contents Account Suspensions Unsuspend Your Account Invalid Login Attempts [Return to Top] Account Suspensions NGSConnex accounts may be suspended for one of the following reasons.  If an [...]

Proper Billing Units for HCPCS Code J7320

Proper Billing Units for HCPCS Code J7320 National Government Services has noticed improper billing units used for HCPCS code J7320, Hyaluronan or derivative, GenVisc 850, for intra-articular injection, 1 mg. GenVisc 850 is indicated for the [...]

Proper Billing for TEZSPIRE™ HCPCS Code J2356

Proper Billing for TEZSPIRE™ HCPCS Code J2356 Table of Contents Proper Billing for TEZSPIRE™ HCPCS Code J2356 Claim Completion Requirements Drug Wastage Appropriate Administration Coding Related Content [Return to Top] Proper [...]

MLN Connects® Newsletter: March 21, 2024

MLN Connects® Newsletter: March 21, 2024 News New Initiative to Increase Investments in Person-Centered Primary Care Marriage and Family Therapists & Mental Health Counselors: Get Information about Billing Medicare Electronic Funds [...]

View Claim Details

View Claim Details Select the Claim Number hyperlink to view additional claim details. If the claim was denied, you can view the reason for denial. You can view the following claim details from the Left-Side navigation. Claim Header [...]

Related Content

Related Content CMS-1500 Claim Form Instructions CMS IOM Publication 100-02, Medicare Benefit Policy Manual CMS IOM Publication 100-04, Medicare Claims Processing Manual Chapter 1 - General Billing Requirements Chapter 12 - [...]

Mental Health Services

Mental Health Services Table of Contents Psychiatric Diagnostic Procedures: 90791‒90792 Interactive Complexity: 90785 Psychotherapy: 90832‒90838 Psychotherapy for Crisis: 90839‒90840 Mobile Psychotherapy for Crisis Services: G0017-G0018 [...]

General Information

General Information Medicare Part B provides benefits for psychiatric services, which are medically necessary for the diagnosis or treatment of diagnostic and/or behavioral health treatment. Medicare recognizes the following Part B providers [...]

Incident-to Services

Incident-to Services A physician, CP, CNS, NP, PA, or CNM may have outpatient psychiatric services and supplies furnished incident to his or her professional service. To be covered under the Incident to provision, the following requirements [...]

CMS Issues Change Request 13294 – Impacts Cost Reports with Disproportionate Share Hospital Reimbursement

CMS Issues Change Request 13294 – Impacts Cost Reports with Disproportionate Share Hospital Reimbursement CMS issued CR 13294,“Change Request (CR) to Implement the Medicare Program Final Action: Treatment of Medicare Part C Days in the [...]

Credit Balance Reminder: Submissions For Quarter Ending 3/31/2024 Start Soon!

Credit Balance Reminder: Submissions For Quarter Ending 3/31/2024 Start Soon! CBR submissions can be submitted starting on 4/1/2024 and are due within 30 days to be considered timely. Remember, even if no monies are owed to Medicare for this [...]

[REVISED] Submitting Paper Claim Forms to National Government Services Due to the Change Healthcare Security Incident

[REVISED] Submitting Paper Claim Forms to National Government Services Due to the Change Healthcare Security Incident As a follow up to our 2/28/2024 article, Change Healthcare Security Incident, providers have asked if they can submit their [...]

Ambulance Physician Certification Statement Guidelines

Ambulance Physician Certification Statement Guidelines Certification Type Certification Required? Yes/No Who May Sign the Certification Timeframe Other Information /Resources Nonemergency, scheduled, [...]

Provider Revalidation Fact Sheet for Congressional Field Offices

Provider Revalidation Fact Sheet for Congressional Field Offices The Affordable Care Act, Section 6401 (a), requires enrolled providers to revalidate their Medicare enrollment every five years, and enrolled durable medical equipment suppliers [...]

Opioid Use Disorder Screening and Treatment: G0402, G0438, G0439, G2011, G0396, G0397

Opioid Use Disorder Screening and Treatment: G0402, G0438, G0439, G2011, G0396, G0397 Medicare coverage includes OUD screening when performed by physicians and NPPs. OUD screening must be performed as part of a Medicare beneficiary’s IPPE and [...]

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers

Provider Qualifications

Provider Qualifications Table of Contents Physicians - Psychiatrists Clinical Psychologist Independently Practicing Psychologist (IPP) Clinical Social Worker Marriage and Family Therapist (MFT) Mental Health Counselor (MHC) Physician [...]