How to Obtain a Refund

A refund will only be granted in the following instances: The application fee was not required for the application submitted A hardship request was subsequently approved and a fee was paid An application was rejected prior to the screening [...]

Eligible Method II Providers

Eligible Method II Providers If a CAH wants to become a Method II biller, email the request to A&R at ngsreimbursement@anthem.com.  Suppliers who can enroll as a Method II Biller Reassignment. Doctor of Medicine (MD) Doctor of [...]

Home Health Certification Statement

Home Health Certification Statement What is a home health certification statement? It is an attestation that the Medicare beneficiary is eligible for home health services. It is a CMS requirement and condition of payment for a home health [...]

Home Health Documentation Checklist

Wound Care Under the Medicare Home Health Benefit

Wound Care Under the Medicare Home Health Benefit Wound care treatment typically involves three skilled nursing interventions, which may be performed at the same time or separately from each other. The three services are: Performing the [...]

Home Health Forms – Which is Required?

Home Health Forms – Which is Required? The Advance Beneficiary Notice/Home Health Change of Care Notice/Notice of Medicare Noncoverage Scenario ABN HHHCN NOMNC Patient met goals under the POC and is being [...]

Homebound Status

Homebound Status A Medicare beneficiary must be confined to the home in order to use their Medicare home health benefit. CMS defines homebound status in the CMS IOM Publication 100-02, Medicare Benefit Policy [...]

Home Health Certifying Provider Change

Home Health Certifying Provider Change Home health certifying physician or NPP changes can occur anytime for a variety of reasons. Some examples may include practitioner retirement or vacation and patient choice. Regardless of the [...]

Medicare Home Health Benefit

Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify

Home Health Plans of Care: Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants Allowed to Certify Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections [...]

Provider Compliance Tips for Home Health Services (Part A Non DRG)

Home Health Referrals

Home Health Referrals The certifying physician or allowed nonphysician practitioner, and/or the acute/post-acute care facility referring the patient for home care must ensure that the medical record justifies the referral for Medicare home [...]

Home Health Referrals

Home Health Referrals Table of Contents Home Health Referrals Order for Home Health Services Documentation to Support Homebound Status Documentation to Support the Need for Skilled Services Documentation Regarding the Face-to-Face [...]

Eligibility Criteria for Face-to-Face Encounters

Eligibility Criteria for Face-to-Face Encounters National Government Services is reminding home health providers that a face-to-face encounter form is not adequate documentation to support that a face-to-face encounter occurred. [...]

Home Health: The Definition of an Allowed Practitioner

Home Health:  The Definition of an Allowed Practitioner As per MM12615 the “Definition of an Allowed Practitioner” has been revised to read as follows (CR 12615): Medicare Benefit Policy Manual Chapter 7 Section 30.2.1 – Definition of an [...]

Home Health Aide Services and the Intermittent or Part-Time Rule

Home Health Aide Services and the Intermittent or  Part-Time Rule Job Aid The CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 7, Section 50.2 states: The reason for the visits by the home health aide must [...]

Medicare Part B Drugs and Biologicals

During this webinar, we’ll provide and in-depth overview of Medicare Part B drug and biological coverage guidelines, pricing, reimbursement and proper billing criteria. We’ll also share educational resources to help ensure proper claim submission.

How to Submit a Hardship Request

To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be considered if it is received [...]

Contact Information and Resources

Contact Information and Resources Inquiry Type Examples Help Desk Contact Information Process of MDPP CDC Recognition Credential via CDC, check status of application for CDC recognition or submitting [...]

Expected Timeframes for Therapy Services

Expected Timeframes for Therapy Services CMS and CPT guidelines for provider time spent and documented on therapy services may vary, depending on the definition of the service and the context in which it is performed. Therapy services [...]

Network Service Vendors

Network Service Vendors National Government Services requires connectivity to the EDI Gateway for exchange of EDI data through select NSVs. In addition to connectivity to the EDI Gateway for the exchange of HIPPAA transactions, these vendors [...]

Minimum System Requirements and Support

Minimum System Requirements and Support PC Print is only compatible with officially supported Microsoft Windows Operating Systems. Please note that PC Print v4.2.6 is the only version compatible with Windows XP. PC Print software allows [...]

Download PC-ACE

Download PC-ACE Download PC-ACE If you intend to administer the COVID-19 vaccines when they become available, or the new monoclonal antibody bamlanivimab, especially if you intend to roster bill these codes, please download and install the [...]

Key Features

Key Features PC Print offers several different report displays and the ability to print the reports as needed. The Single Claim Report includes the activity at the claim and detail line items for a single claim. The All Claims Report [...]

About PC Print

About PC Print The PC Print software is available for providers to view and print HIPAA-compliant ERAs from their own computer. The PC Print software is available to you at no cost. This software is easy to use and will save you both time and [...]

View and Print ERA in PC-ACE

View and Print ERA in PC-ACE PC-ACE offers the ability to translate an ERA to either view and/or print for both institutional and professional ERAs after they have been downloaded. ERAs viewed/printed in PC-ACE provides the same data that is [...]

PC-ACE Quick Reference Guide: Medicare Secondary Payer

PC-ACE Quick Reference Guide: Medicare Secondary Payer The following are Medicare A (Institutional) instructions for entering line item and claim information into PC-ACE when Medicare is the secondary payer. Situations where Medicare is the [...]

Creating a 276 Claim Status Request in PC-ACE

Creating a 276 Claim Status Request in PC-ACE Claim Status Request Files must be prepared and transmitted using communication software. Select INST or PROF from the PC-ACE Claims Processing System main menu.   Select List Claims [...]

PC-ACE for Institutional Users: Importing and Reading the 999 and 277CA Files

PC-ACE: Importing and Reading the 999 and 277CA Files In order for PC-ACE to read 999 or 277CA files, they must be saved into the proper sub-folder within the WINPCACE folder. 277CA files go within the Stat1500 (Part B) sub-folder or the [...]

Minimum System Requirements and Support

Minimum System Requirements and Support Minimum System Requirements SVGA monitor resolution (800 x 600) Windows 10, Windows 8.1, Windows 7 or Vista operating system Adobe Acrobat Reader Version 4.0 or later (for overlaid claim printing) [...]

Key Features

Key Features PC-ACE is a comprehensive claims management system. Some of the more prominent features include: Combined Medicare Part A, Institutional All-Payer and Professional claims system Electronic submission of claims in ANSI-837 [...]

Setting Your Security Questions

Setting Your Security Questions Setting up Security Questions is part of the required process for establishing an EDI Gateway Self-Service Portal account. Follow these steps to set up your account Security Questions. Access the Trading [...]

Password Reset Requirements Checklist

Password Reset Requirements Checklist The following information will assist you in successfully resetting your password and eliminate any unnecessary disconnects. You should note that passwords expire every 60 days and can be reset prior to [...]

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 [...]

Changing Your EDI Password

Changing 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 change your [...]

EDI Gateway Self-Service Password Portal Overview

EDI Gateway Self-Service Password Portal Overview Table of Contents EDI Gateway Self-Service Password Portal Overview Changing versus Resetting Your Password Changing Your Password Resetting Your Password EDI Gateway Self-Service [...]

Standard Companion Guide Trading Partner Information

Standard Companion Guide Trading Partner Information Instructions Related to the X12 278 and 275 Prior Authorization Transactions Companion Guide Version Number: 1.0 Created: April, 2022 Preface Companion Guides (CG) may contain two types of [...]

Related Content

Related Content WPC Health Care Code Lists Health Care Payment and Remittance Advice: Provides information on ERA and companion documents for assistance with receiving the Transaction 835. CMS IOM Publication, Medicare Claims Processing [...]

Standard Companion Guide Trading Partner Information

Standard Companion Guide Trading Partner Information Instructions Related to the X12 275 Claims Attachment Version 6020 and HL7 Consolidated Clinical Document Architecture R2.1 Companion Guide Version Number: 7.0 Revised: February 2024 [...]

Standard Companion Guide Trading Partner Information

Standard Companion Guide Trading Partner Information Instructions Related to the X12 277 Health Care Claim Request for Additional Information Version 6020 Companion Guide Version Number: 6.0 Revised: October 2019 Preface Companion Guides [...]

Participating Clearinghouses and Vendors

Participating Clearinghouses and Vendors The following entities support electronic attachments with NGS. Any of these entities can assist you with implementing electronic attachments and participating in the NGS Attachment Program. [...]

How to Get Started

How to Get Started Making the change is easy. If you use a clearinghouse to submit claims, contact your clearinghouse to ask how to enroll for the electronic remittance service. If you currently have a claim submission software program, [...]

Benefits of the 277 RFI

Benefits of the 277 RFI The X12 277 RFI transaction replaces the paper Additional Development Request letters. The 277RFI transaction is available for JK/J6 Part A and Part B providers. The benefits of the 277RFI transaction include: [...]

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 [...]

Duplicate Claim Editing Information

Duplicate Claim Editing Information National Government Services implemented a Part A duplicate claim edit in our EDI front-end processing system. Providers are notified that a claim is a duplicate upon receipt of the 277 Claims [...]

Benefits of Electronic Remittance Advice

Benefits of Electronic Remittance Advice Table of Contents Benefits of Electronic Remittance Advice There Are Several Benefits to Choosing ERA Versus SPR Help Interpreting the ERA Is Available [Return to Top] Benefits of Electronic [...]

Participating Clearinghouses and Vendors

Participating Clearinghouses and Vendors The following entities support electronic attachments with NGS. Any of these entities can assist you with implementing electronic attachments and participating in the NGS Attachment Program. [...]

Benefits of Electronic Attachments

Benefits of Electronic Attachments The X12 275 Attachment transaction supports sending additional documentation electronically. Clinical documentation includes but not limited to; operative notes, consult notes, procedure notes, care plan, and [...]

EDI and How it Works

EDI and How it Works EDI is an electronic communication method that enables fast, accurate and reliable exchange of data between the computer systems of organizations that do business together by using the same standardized message formatting, [...]

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 275 transaction; HL7 CDA R2 [...]

Benefits of EDI and Real Time Claim Status

Table of Contents Benefits of EDI and Real Time Claim Status Real Time Claim Status and Response - A Faster Better Option [Return to Top] Benefits of EDI and Real Time Claim Status There are a number of advantages to enrolling and [...]

PECOS Starter Guide

PECOS Starter Guide Follow the steps outlined below to assist you and your staff with the PECOS processes. Table of Contents New/Initial Enrollee Revalidation Return for Corrections Change of Information Submit Pending Application [...]

Chiropractic Resources

Medicare Coverage of Chiropractic Services Chiropractic Resources Code of Federal Regulations Code of Federal Regulations (Annual Edition) web page 42 CFR Section 410.21 describes limitations on services of a chiropractor 42 CFR [...]

New York State Ambulance Services in Rural Areas (for JK providers only)

New York State Ambulance Services in Rural Areas NYS has unique requirements for the payment of paramedic intercept services when an ambulance company can provide only BLS services. Paramedic intercept services can be approved in counties and [...]

Original Medicare First Level of Appeal Tips Sheet for Medicare Providers

Original Medicare First Level of Appeal Tips Sheet for Medicare Providers If you disagree with Medicare’s claim determination, you may appeal. However, please follow these important tips before you submit a first level of appeal [...]

Coverage of Rural Air Ambulance Services

Coverage of Rural Air Ambulance Services Section 415 of the Medicare Modernization Act of 2003 provides coverage for rural air ambulance services that are reasonable and necessary and ordered by qualified personnel. Medicare considers the [...]

Advance Beneficiary Notice of Noncoverage Liability

Medicare Coverage of Chiropractic Services Advance Beneficiary Notice of Noncoverage Liability The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is a standardized notice that a health care provider/supplier or his/her [...]

MLN Connects® Newsletter: September 12, 2024

MLN Connects® Newsletter: September 12, 2024 News COVID-19: Updated Vaccines for 2024–2025 Season Rural Emergency Hospital Provisions, Conversion Process, & Conditions of Participation: Revised Guidance CMS Roundup (September 6, 2024) [...]

Understanding Authorized Official and Delegated Official Roles

Table of Contents Understanding Authorized Official and Delegated Official Roles Medicare Enrollment Records CMS Identity and Access Management System [Return to Top] Understanding Authorized Official and Delegated Official Roles [...]

PECOS Starter Guide

PECOS Starter Guide Follow the steps outlined below to assist you and your staff with the PECOS processes. New/Initial Enrollee Revalidation Return for Corrections Change of Information Submit Pending Application Add a New [...]