Eligibility

ClaimTimelyFilingCalc-footer

Claims for services furnished to Medicare beneficiaries must be filed to the appropriate MAC no later than one calendar year after the date the services were rendered. Revised 10/20/2021

Care Management

American Medical Association’s Behavioral Health Integration Webinar Series

American Medical Association’s Behavioral Health Integration Webinar Series National Government Services is excited to provide some additional resources on BHI from the AMA. This webinar series, titled “BHI Overcoming Obstacles”, will prepare [...]

Additional Development Requests

Three Ways to Protect Your Medicare Enrollment Information

Protect Your Identity and Privacy

Protect Your Identity and Privacy

Help Prevent Bank Account Fraud

Common Claim Status/Locations

Resources Common Claim Status/Locations Status/Location Claim Disposition P B9996 Claim waiting the payment floor hold P B9997 Processed claim – finalized location P O9998 Processed claim [...]

FISS Reason Code Overview

Resources FISS Reason Code Overview FISS reason codes are five-digit codes that direct the outcome of a claim edit or process; they are the “traffic cops” of the system. The following chart outlines the various positions of the FISS reason [...]

Program Function/Escape Key Crosswalk

Resources  Program Function/Escape Key Crosswalk Program Function Key FISS/DDE <Esc> X-Walk Function F1/PF1 Esc 1 Serves as a “Help” key. Allows you to access information contained on the [...]

Ambulance Attachment (43)

Chapter VI: Claims Correction Submenu (03) Ambulance Attachment (43) Purpose Not applicable This option is currently not utilized by National Government Services. Revised 9/18/2018

Pacemaker Attachment (42)

Chapter VI: Claims Correction Submenu (03) Pacemaker Attachment (42) Purpose Not applicable This Fiscal Intermediary Standard System (FISS)/Direct Data Entry (DDE) Provider Online System option is not utilized as Medicare no longer [...]

Home Health Attachment (45)

Chapter VI: Claims Correction Submenu (03) Home Health Attachment (45) Purpose Not applicable This Fiscal Intermediary Standard System (FISS)/Direct Data Entry (DDE) Provider Online System option is not utilized. Revised 9/9/2016

ESRD CMS-382 Form Attachment (57)

Chapter V: Claims/Attachments Submenu (02) ESRD CMS-382 Form Attachment (57) Purpose This feature allows the user the capability to enter either a new CMS-382 form or a new method selection. Note: Per CR 7064, ESRD PPS was implemented [...]

Printing FISS Screens

Chapter III: Navigating the Online System Printing FISS Screens There are two print options available in FISS that will allow you to print any screen or multiple screens. From the File menu, select Print Screen to send a single screen to [...]

Online Reports View Submenu

Chapter II: Online Menu Functions Overview Online Reports View Submenu Purpose      In the ONLINE REPORTS VIEW submenu, providers can view a variety of reports, as well as submit their quarterly Credit Balance [...]

Claims Correction Submenu

Chapter II: Online Menu Functions Overview Claims Correction Submenu Purpose The CLAIMS CORRECTION submenu is where providers correct RTP claims, adjust processed or rejected claims and cancel processed claims. This submenu also contains [...]

Accessing the Common Working File

Introduction Accessing the Common Working File Beneficiary eligibility records, which are maintained for CMS by the SSA, are stored electronically in the CWF system. You can access CWF records to view beneficiary eligibility information in [...]

Electronic Submissions

Introduction Electronic Submissions The FISS/DDE system is available through either a leased line connection or dial-up connection using a personal computer and modem. You should have knowledge of your setup since there are a [...]

Electronic Data Interchange (EDI)

Appeals

LCDs & NCDs

EDI E-mail Inquiry Form Bottom

Once you submit your completed form, you should receive an automated acknowledgement stating your email inquiry has been received by EDI. Response time for email inquiries is within ten business days of receipt. Please make sure you [...]

Part B Remittance Statements Missing Financial Control Numbers

Due to an issue associated with the 10/1/2021 release, Part B remittances classified as withholding (WO) are being generated without FCN information. Without the necessary control number, providers cannot cross-reference the reason for [...]

Check Provider Enrollment Application Status

This inquiry tool can be used to check on the status of your application. How to Search To perform a search please enter into a field below either a valid Case Number/Web Tracking ID (Option 1) or a valid National Provider [...]

Technical Guides and Information

Technical Guides and Information 5010 Process Flow Chart X12 Website: Technical Reports/Implementation Guides, Newsletters and X12 Transaction Sets

Accessing the Inquiries Submenu

Chapter IV: Inquiries Submenu (01) Accessing the Inquiries Submenu Purpose This section explains how to access the Inquiries submenu from the Main Menu. Task To access the Inquiries submenu from the FISS/DDE Provider Online System Main [...]

MLN Connects® Special Edition for Wednesday, April 14, 2021

MLN Connects® Special Edition for Wednesday, April 14, 2021 J&J COVID-19 Vaccine: Health Alert The CDC issued a Health Alert, about the CDC and FDA’s recommended pause in the use of the J&J COVID-19 vaccine, in part, to ensure that [...]

MLN Connects® Special Edition for Tuesday, April 20, 2021

MLN Connects® Special Edition for Tuesday, April 20, 2021 COVID-19 Update: FDA Revoked the EUA for Bamlanivimab When Administered Alone On April 16, the FDA revoked the Emergency Use Authorization (EUA) for bamlanivimab, when administered [...]

MLN Connects® for Thursday, May 20, 2021

MLN Connects® for Thursday, May 20, 2021 Mental Health: Medicare Covers Preventive Services View this edition as a: Webpage | PDF News Hospice Outcomes & Patient Evaluation: Submit Beta Test Application by June 14 Mental [...]

MLN Connects® for Thursday, June 3, 2021

MLN Connects® for Thursday, June 3, 2021 MACs Resume Medical Review View this edition as a: Webpage | PDF News Medicare Shared Savings Program: Submit Notice of Intent to Apply by June 7 Clinical Diagnostic Laboratories: Key Dates [...]

MLN Connects® Newsletter for Thursday, July 8, 2021

MLN Connects® Newsletter for Thursday, July 8, 2021 COVID-19 Accelerated and Advance Payments: Updated FAQs View this edition as a: Webpage | PDF News COVID-19 Accelerated and Advance Payments: Updated FAQs COVID-19 Snapshot: [...]

MLN Connects® Newsletter for Thursday, July 22, 2021

MLN Connects® Newsletter for Thursday, July 22, 2021 COVID-19: EUA for Tocilizumab Monoclonal Antibody Product View this edition as a: Webpage | PDF News COVID-19: EUA for Tocilizumab Monoclonal Antibody Product Medicare Ground [...]

Evaluation and Management

Reopening versus Redetermination

MLN Connects® for Thursday, January 14, 2021

MLN Connects® for Thursday, January 14, 2021 Ensuring our Nation’s Seniors Have Access to Latest Advancements View this edition as a: Webpage | PDF News Ensuring our Nation’s Seniors Have Access to Latest Advancements Opioid [...]

MLN Connects® for Thursday, March 18, 2021

MLN Connects® for Thursday, March 18, 2021 Open Payments & You – Register for March 25 Call View this edition as a: Webpage | PDF News Clinical Laboratory Data Reporting Delayed Until 2022: Reminder Comprehensive Eye [...]

MLN Connects® Newsletter for Thursday, August 12, 2021

MLN Connects® Newsletter for Thursday, August 12, 2021 COVID-19: Vaccinate Your Patients View this edition as a: Webpage | PDF News COVID-19: Vaccinate Your Patients CMS Resumes Targeted Probe & Educate Program Compliance [...]

NGSConnex: Initiate and View Confirmation of Part A Quarterly Credit Balance Reports

NGSConnex: Initiate and View Confirmation of Part A Quarterly Credit Balance Reports Did you know as a Part A, HH+H and FQHC provider, you are able to use our secure self-service portal, NGSConnex, to submit your quarterly credit balance [...]

MLN Connects® for Thursday, January 21, 2021

MLN Connects® for Thursday, January 21, 2021 Give Flu Shots through January & Beyond View this edition as a: Webpage | PDF News Hospital IPPS: FAQs on Market-Based MS-DRG Relative Weights MLN Web-Based Training: Complete Training [...]

MLN Connects® for Thursday, February 11, 2021

MLN Connects® for Thursday, February 11, 2021 PFS Payment for Office & Outpatient E/M Visits View this edition as a: Webpage | PDF News Flu & Pneumococcal Shots: Protect Your Patients Compliance Hospices: Create an [...]

MLN Connects® Newsletter for Thursday, June 24, 2021

MLN Connects® Newsletter for Thursday, June 24, 2021 2019 Quality Payment Program: Performance Information on Care Compare View this edition as a: Webpage | PDF News 2019 Quality Payment Program: Performance Information on Care Compare [...]

MLN Connects® Special Edition for Wednesday, March 10, 2021

MLN Connects® Special Edition for Wednesday, March 10, 2021 CMS Updates Nursing Home Guidance with Revised Visitation Recommendations On March 10, CMS, in collaboration with the CDC, issued updated guidance for nursing homes to safely expand [...]

MLN Connects® Special Edition for Thursday, April 8, 2021

MLN Connects® Special Edition for Thursday, April 8, 2021 4 Proposed FY 2020 Payment Rules SNF Prospective Payment System: FY 2022 Proposed Rule Hospice Payment Rate Update for FY 2022 IRF Prospective Payment System: FY 2022 Proposed Rule [...]

MLN Connects® for Thursday, April 22, 2021

MLN Connects® for Thursday, April 22, 2021 COVID-19: Partnership to Vaccinate Dialysis Patients & Health Care Personnel View this edition as a: Webpage | PDF News Dialysis Facilities: Partnership to Vaccinate Dialysis Patients [...]

MLN Connects® Newsletter for Thursday, July 1, 2021

MLN Connects® Newsletter for Thursday, July 1, 2021 Quality Payment Program: 2021 APM Incentive Payments View this edition as a: Webpage | PDF News Quality Payment Program: 2021 APM Incentive Payments Compliance Inhalant Drugs: [...]

MLN Connects® Special Edition for Thursday, July 1, 2021

MLN Connects® Special Edition for Thursday, July 1, 2021 CMS Proposes Changes to Reduce Health Care Disparities Among Patients with Chronic Kidney Disease and End-Stage Renal Disease Proposed changes mark Innovation Center’s first direct [...]

MLN Connects® Newsletter for Thursday, August 5, 2021

MLN Connects® Newsletter for Thursday, August 5, 2021 Coverage to Care & Connected Care View this edition as a: Webpage | PDF News Clinical Diagnostic Laboratories: Private Payor Rate-Based CLFS Resources Coverage to Care & [...]

MLN Connects® Special Edition for Friday, December 17, 2021

MLN Connects® Special Edition for Friday, December 17, 2021 CMS Funding 1,000 New Residency Slots for Hospitals Serving Rural & Underserved Communities Administration takes action to address access to care, workforce shortages in [...]

Provider Enrollment Appeals and Rebuttal

Provider Enrollment Appeals and Rebuttal

J6 Applying for an Extended Repayment Schedule

MLN Connects® Newsletter for Thursday, June 17, 2021

MLN Connects® Newsletter for Thursday, June 17, 2021 COVID-19: EUAs for Monoclonal Antibody Products View this edition as a: Webpage | PDF News COVID-19: EUA for Sotrovimab Monoclonal Antibody Product COVID-19: EUA for Regeneron [...]

MLN Connects® Newsletter for Thursday, June 10, 2021

MLN Connects® Newsletter for Thursday, June 10, 2021 Cognitive Assessment: What’s in the Written Care Plan? View this edition as a: Webpage | PDF News Cognitive Assessment: What’s in the Written Care Plan? Hospital Outpatient [...]

MLN Connects® Special Edition for Monday, June 28, 2021

MLN Connects® Special Edition for Monday, June 28, 2021 CMS to Improve Home Health Services for Older Adults and People with Disabilities Proposed rule would accelerate shift from volume-based incentives to quality-based incentives CMS [...]

MLN Connects® for Thursday, May 27, 2021

MLN Connects® for Thursday, May 27, 2021 Critical Care E/M Services: Comparative Billing Report View this edition as a: Webpage | PDF News Critical Care Evaluation & Management Services: Comparative Billing Report in May [...]

MLN Connects® for Thursday, May 13, 2021

MLN Connects® for Thursday, May 13, 2021 Cognitive Impairment: Medicare Provides Opportunities to Detect & Diagnose View this edition as a: Webpage | PDF News Cognitive Impairment: Medicare Provides Opportunities to Detect & [...]

MLN Connects® Special Edition for Tuesday, May 11, 2021

MLN Connects® Special Edition for Tuesday, May 11, 2021 CMS Expanding Efforts to Grow COVID-19 Vaccine Confidence and Uptake Amongst Nation’s Most Vulnerable CMS Builds on Whole-of-Government COVID-19 Response with Vaccination Education, [...]