Search Results - NGSMEDICARE

Posting Date: 04/07/2025

38200

Avoiding/Correcting This Error Always verify the status of a submitted claim before submitting another claim. Verify claim status using the IVR system, FISS/DDE or the NGSConnex online portal. Per CMS mandate, PCC representatives are not [...]

Posting Date: 04/07/2025

C7010

Avoiding/Correcting This Error If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient). Verify hospice enrollment prior to claim submission by reviewing the CWF, the [...]

Posting Date: 04/07/2025

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the IVR system, the [...]

Posting Date: 04/07/2025

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider [...]

Posting Date: 04/07/2025

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

Posting Date: 04/07/2025

38312

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim. To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]

Posting Date: 04/07/2025

38031

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim. To prevent this error on future claims, ensure you have received all charges from all departments and that no claim has been submitted for the same DOS and [...]

Posting Date: 04/07/2025

W7113

Avoiding/Correcting This Error Prevent future similar errors by checking the I/OCE and ICD-10 official guidelines prior to claim submission. Verify the diagnosis codes reported; correct and resubmit. Related Content The I/OCE Quarterly [...]

Posting Date: 04/07/2025

34963

Avoiding/Correcting This Error Verify billing and, if appropriate correct and return the claim. Online providers should press PF9 to restore the claim. Related Content New Fiscal Intermediary Shared System Consistency Edit to Validate [...]

Posting Date: 04/07/2025

32078

Avoiding/Correcting This Error Ensure the appropriate revenue code(s) and HCPCS/CPT code(s) are reported on the claim and each claim line contains the correct service date. Verify the information billed and PF9 to resubmit. Related [...]

Posting Date: 04/07/2025

W7072

Avoiding/Correcting This Error Verify billing and, if appropriate, correct and resubmit the claim for payment. Related Content Centers for Medicare & Medicaid Services Internet-Only Manual Publication 100-04, Medicare Claims Processing [...]

Posting Date: 04/07/2025

W7089

Avoiding/Correcting This Error Payment for a FQHC encounter requires a medically necessary face-to-face visit. Each FQHC specific payment code (G0466-G0470) must have a corresponding service line with a HCPCS code that describes the qualifying [...]

Posting Date: 04/07/2025

32404

Verify HCPCS code using the FISS Inquiries HCPCS file (option 14). Allowable HCPCS codes will be displayed based on DOS. Avoiding/Correcting This Error Use the claims correction option to report the appropriate HCPCS/CPT code and resubmit the [...]

Posting Date: 04/07/2025

32402

Avoiding/Correcting This Error Verify HCPCS code using the FISS DDE Inquiries HCPCS file (option 14) to determine the allowable revenue codes based upon the date of service. Verify billing and, if appropriate, correct the claim using the [...]

Posting Date: 04/07/2025

N5052

Avoiding/Correcting This Error The beneficiary’s name listed on the claim has to be an exact match to what is posted on CWF. Be sure that any special characters (including apostrophes, dashes, commas) and suffixes (Jr., Sr., III) that are [...]

Posting Date: 04/07/2025

32243

Avoiding/Correcting This Error Review the claim and either update the charges or remove the line containing zero or blank charges. Return the claim for processing.

Posting Date: 04/07/2025

W7089

Avoiding/Correcting This Error Payment for a FQHC encounter requires a medically necessary face-to-face visit. Each FQHC specific payment code (G0466-G0470) must have a corresponding service line with a HCPCS code that describes the qualifying [...]

Posting Date: 04/07/2025

32266

Avoiding/Correcting This Error Report influenza virus, pneumococcal pneumonia virus, and COVID-19 vaccines (and administration) with your charges on the 77X claim for informational and data collection purposes only. Report revenue code 0771 [...]

Posting Date: 04/07/2025

W7088

Avoiding/Correcting This Error Each FQHC PPS claim must be billed with a qualifying visit code, and associated line-item charges, along with all other FQHC services furnished during the encounter. A qualifying visit code is the code that [...]

Posting Date: 04/07/2025

W7088

Avoiding/Correcting This Error Each FQHC PPS claim must be billed with a qualifying visit code, and associated line-item charges, along with all other FQHC services furnished during the encounter. A qualifying visit code is the code that [...]

Posting Date: 04/07/2025

37098

Avoiding/Correcting This Error Verify billing and, if appropriate, correct and return the claim. Related Content Billing for FQHC MAO Plan Supplemental Payment (PPS Providers) CMS Internet-Only Manual 100-04, Medicare Claims Processing [...]

Posting Date: 01/03/2024

About PC-ACE

About PC-ACE The National Government Services PC-ACE free billing software is available for NGS J6 and JK providers only. If you are not a J6 or JK provider, the free billing software must be obtained from your MAC. PC-ACE is a [...]

Posting Date: 01/03/2024

About PC-ACE

About PC-ACE The National Government Services PC-ACE free billing software is available for NGS J6 and JK providers only. If you are not a J6 or JK provider, the free billing software must be obtained from your MAC. PC-ACE is a stand-alone [...]

Posting Date: 01/03/2024

PCACE Full Install Text - ALOB

Version 6.6 (Institutional and Professional) PC-ACE users

Posting Date: 01/03/2024

PCACE Upgrade Text - ALOB

Version 6.6 (Institutional and Professional) PC-ACE users

Posting Date: 01/03/2024

PCACE Download Text - ALOB

The installation code to run the full install or the upgrade for PC-ACE is: NGSMAC1 Important Warning: For PC-ACE version 6.6 updated version: please be patient and allow the full install or update complete. It is important that you do not [...]

Posting Date: 04/08/2025

Upcoming Annual Logon ID Recertification for Minnesota Region

Upcoming Annual Logon ID Recertification for Minnesota Region All users who access the FISS DDE system are required by the CMS to recertify their access annually. National Government Services will designate one state at a time to complete the [...]

Posting Date: 04/09/2025

59301

Avoiding/Correcting This Error You have the right to submit an appeal when you believe the medical records support that the denied services were reasonable and medically necessary. To prevent similar denials, ensure that all coverage [...]

Posting Date: 04/09/2025

32402

Avoiding/Correcting This Error Verify HCPCS code using the FISS DDE Inquiries HCPCS file (option 14) to determine the allowable revenue codes based upon the date of service. Verify billing and, if appropriate, correct the claim using the [...]

Posting Date: 04/09/2025

32402

Avoiding/Correcting This Error Verify HCPCS code using the FISS Inquiries HCPCS file (option 14). Allowable revenue codes will be displayed based on DOS. Use the claims correction option to report the appropriate HCPCS/CPT code and resubmit [...]

Posting Date: 04/09/2025

34963

Avoiding/Correcting This Error Verify billing and, if appropriate correct and return the claim. Online providers should press PF9 to restore the claim. Related Content New Fiscal Intermediary Shared System Consistency Edit to Validate [...]

Posting Date: 04/09/2025

34963

Avoiding/Correcting This Error Verify billing and, if appropriate correct and return the claim. Online providers should press PF9 to restore the claim. Related Content New Fiscal Intermediary Shared System Consistency Edit to Validate [...]

Posting Date: 04/09/2025

34977

Avoiding/Correcting This Error If you are billing for on-campus services only: Report the billing provider address only in the billing provider loop 2010AA Do not report any service facility location in loop 2310E (or in DDE MAP 171F [...]

Posting Date: 04/09/2025

34977

Avoiding/Correcting This Error If you are billing for on-campus services only: Report the billing provider address only in the billing provider loop 2010AA Do not report any service facility location in loop 2310E (or in DDE MAP 171F [...]

Posting Date: 04/09/2025

34986

Avoiding/Correcting This Error The PN modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus outpatient, PBD of a hospital. The PN modifier applies to a grandfather/excepted PBD for [...]

Posting Date: 04/09/2025

34985

Avoiding/Correcting This Error The PO modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus provider-based outpatient department (PBD). The PO modifier applies to a [...]

Posting Date: 04/09/2025

34985

Avoiding/Correcting This Error The PO modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus provider-based outpatient department (PBD). The PO modifier applies to a [...]

Posting Date: 04/09/2025

34986

Avoiding/Correcting This Error The PN modifier is used on all claim lines for all services, procedures and/or surgeries provided at an excepted off-campus outpatient, PBD of a hospital. The PN modifier applies to a grandfather/excepted PBD for [...]

Posting Date: 04/09/2025

38119

SNF inpatient claims have to be processed in sequence. That means that when the beneficiary is going to be in the SNF as an inpatient for several months in a row, claims for the months the beneficiary is in the SNF must be submitted one at a [...]

Posting Date: 04/09/2025

37098

Avoiding/Correcting This Error Verify billing and, if appropriate, correct and return the claim. Related Content Billing for FQHC MAO Plan Supplemental Payment (PPS Providers) CMS Internet-Only Manual 100-04, Medicare Claims Processing [...]

Posting Date: 04/09/2025

38038

Avoiding/Correcting This Error Check OPPS claims for potential overlapping dates of service prior to claim submission and bill accordingly An adjustment bill must be submitted For bill type 34X, only vaccines and their administration, [...]

Posting Date: 04/09/2025

U5065

Avoiding/Correcting This Error Check/verify the beneficiary's entitlement dates in the CWF. A Medicare beneficiary, or their authorized representative, may have requested a new MBI. Verify eligibility and MBI number, correct and return the claim.

Posting Date: 04/09/2025

38119

Avoiding/Correcting This Error Verify the admission date and from date on this claim Verify the patient’s MBI to make sure that it has been correctly reported If the MBI is incorrect, this edit will be assigned If admission and from dates [...]

Posting Date: 04/09/2025

U5065

Avoiding/Correcting This Error HH+H may only bill services provided to the patient after the effective date of their Medicare coverage. Verify the effective date(s) for the MBI of the beneficiary prior to billing. If a new MBI has been issued [...]

Posting Date: 04/09/2025

U5065

Avoiding/Correcting This Error Check/verify the beneficiary's entitlement dates in the CWF. A Medicare beneficiary, or their authorized representative, may have requested a new MBI. Verify eligibility and MBI number, correct and return the claim.

Posting Date: 04/09/2025

U5065

Avoiding/Correcting This Error Check/verify the beneficiary's entitlement dates in the CWF. A Medicare beneficiary, or their authorized representative, may have requested a new MBI. Verify eligibility and MBI number, correct and return the claim.

Posting Date: 04/09/2025

U5065

Avoiding/Correcting This Error HHH may only bill services provided to the patient after the effective date of their Medicare coverage. Verify the effective date(s) for the MBI of the beneficiary prior to billing. If a new MBI has been issued [...]

Posting Date: 04/09/2025

W7088

Avoiding/Correcting This Error Each FQHC PPS claim must be billed with a qualifying visit code, and associated line-item charges, along with all other FQHC services furnished during the encounter. A qualifying visit code is the code that [...]

Posting Date: 04/09/2025

52MUE

Avoiding/Correcting This Error You have the right to submit an appeal when you believe the medical records support that the denied services were reasonable and medically necessary. Providers should review the information on the CMS website [...]

Posting Date: 04/09/2025

52NCD

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

Posting Date: 04/09/2025

54NCD

Avoiding/Correcting This Error Review coverage guidelines for the service being denied to ensure medical necessity of the services being provided to the beneficiary. Ensure all Medicare coverage and medical necessity requirements are met [...]

Posting Date: 04/09/2025

52NCD

Avoiding/Correcting This Error Ensure all Medicare coverage and medical necessity requirements are met prior to billing. If the provider determines that Medicare will not cover the services, consider submitting the charges as noncovered. [...]

Posting Date: 04/09/2025

55B31

Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity. When you receive an ADR from National Government [...]

Posting Date: 04/09/2025

55B31

Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity. When you receive an ADR from National Government [...]

Posting Date: 04/09/2025

55S29

Avoiding/Correcting This Error Respond promptly to a MAC, CERT, RAC, SMRC, or UPIC request for additional documentation. Documentation is necessary to verify compliance with a benefit category requirement. Ensure that all records, [...]

Posting Date: 04/09/2025

55S05

Avoiding/Correcting this Error The SNF should ensure that SNF services that are not covered are identified. After discussion with the beneficiary and/or representative you should properly issue an ABN and bill for the noncovered services [...]

Posting Date: 04/09/2025

39928

Avoiding/Correcting This Error To access the line level reason associated with this reason code providers should go to claim page (2) (MAP 1712) and F11 to MAP171D to see the line level denial codes for each line of the claim. If you disagree [...]

Posting Date: 04/09/2025

5ND07

Avoiding/Correcting This Error To prevent this error, ensure all Medicare coverage and medical necessity requirements are met prior to billing. Providers can visit the CMS Coverage Database to review the NCDs and LCDs to determine the [...]

Posting Date: 04/09/2025

59118

Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]

Posting Date: 04/09/2025

59118

Avoiding/Correcting This Error Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN® Matters articles for relevant ICD-10 updates. The most current MLN Matters [...]