What Should Be Provided if Medical Records Are Requested for Review?

What Should Be Provided if Medical Records Are Requested for Review? The following should be considered if applicable to the service being reviewed. This is not intended to be an all-inclusive list. Progress/visit notes Physician orders [...]

Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate

Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate Table of Contents Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate Background: Standard Payment vs. [...]

Claims for Drugs Without a Product-Specific Code Assigned

Claims for Drugs Without a Product-Specific Code Assigned National Government Services has noticed that when a claim RTPs for additional information to be added to the Remarks field concerning certain drugs, some providers attempt to provide [...]

Denials for HCPCS G2211

NCCI editing for HCPCS G2211 code was updated on 12/05/2024 to require HCPCS G0463 as the primary code for G2211 add-on code. This has resulted in denials of claims for the add-code G2211 when billed with CPTs 99202-99205 and 99211-99215. [...]

REVALIDATION: How do I know I need to revalidate?

REVALIDATION: Where is the revalidation notification letter sent?

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

APPLICATION FEE: Who needs to pay an application fee?

APPROVAL RECOMMENDATION STATUS: The status of my application is approval recommendation, how can I verify if the state agency or CMS has completed their process?

APPLICATION STATUS: Where can I find the status of a submitted application?

DETERMINATION LETTER: How can I get a copy of the determination (approval/denial) letter for a submitted application?

DETERMINATION LETTER: Where are the determination (approval/denial) letters sent?

PECOS: I received an email to sign an application; how do I do this?

REVALIDATION: How do I know I need to revalidate?

SIGNATURES: Who signs the CMS applications and forms for an entity? (ex. 855A, 855B, 20134, 460, 588)

SIGNATURES: Who signs the CMS-855I application?

Provider Contact Center – Make the Most of Your Call

Provider Contact Center – Make the Most of Your Call Effective 5/1/2025, the Provider Contact Center (PCC) will service one PTAN/NPI combination per call. Before calling the PCC, make the most of your call by ensuring you have all [...]

APPROVAL RECOMMENDATION STATUS: The status of my application is approval recommendation, how can I verify if the state agency or CMS has completed their process?

Provider Contact Center

Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Written Correspondence and Inquiries [...]

Provider Contact Center

Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Written Correspondence and Inquiries [...]

DETERMINATION LETTER: How can I get a copy of the determination (approval/denial) letter for a submitted application?

DETERMINATION LETTER: Where are the determination (approval/denial) letters sent?

PECOS: I received an email to sign an application; how do I do this?

PECOS: In PECOS, how do I know if the authorized/delegated official or individual provider signed the application?

PECOS: In PECOS, please advise how to respond when the MAC needs additional information or supporting documentation for a submitted application.

REVALIDATION: Where is the revalidation notification letter sent?

REVALIDATION: Do I need to revalidate if it has not been five years since my last revalidation?

PECOS: In PECOS, how do you find an enrollment to submit an application?

PECOS: In PECOS, please advise how to respond when the MAC needs additional information or supporting documentation for submitted application.

PECOS: In PECOS, how do I submit an application?

PECOS: In PECOS, how do I know what enrollment information Medicare currently has on file for a provider or supplier?

APPROVAL RECOMMENDATION STATUS: Whom can I contact for questions about an application in approval recommendation status?

REVALIDATION: Do I need to revalidate if it has not been five years since my last revalidation?

PECOS: In PECOS, how do I know if the authorized/delegated official or individual provider signed the application?

PECOS: In PECOS, how do I know what enrollment information Medicare currently has on file for a provider or supplier?

PECOS: In PECOS, how do you find an enrollment to submit an application?

PECOS: In PECOS, how do I submit an application?

CMS-855I: Who needs to sign the CMS-855I for a reassignment?

CMS-855I: How do I complete a reassignment?

APPROVAL RECOMMENDATION STATUS: Whom can I contact for questions about an application in approval recommendation status?

APPLICATION FEE: What is the amount of the application fee?

National Government Services Medicare Part B Redetermination Notice Initiative Is Here

National Government Services Medicare Part B Redetermination Notice Initiative Is Here As previously announced, National Government Services is pleased to announce we are discontinuing issuing paper MRNs for requests submitted electronically [...]

Provider Enrollment

Medicare Part B 101 Manual Provider Enrollment Table of Contents National Provider Identifier Required Tips for Successfully Enrolling with the Medicare Part B Contractor When Mailing Paper Applications Tip 1: Submit the correct [...]

CMS Is Using Multi-Factor Authentication Process for Online Provider Enrollment System Applications

CMS Is Using Multi-Factor Authentication Process for Online Provider Enrollment System Applications CMS announced they utilize an MFA process for users of their Provider Enrollment Systems.  MFA is a second layer of security used to [...]

[RESOLVED] NGS Phone Lines Currently Unavailable

[RESOLVED] NGS Phone Lines Experiencing Outages The outages we were experiencing with our Provider Contact Center telephone lines have now been resolved. This includes EDI, Provider Enrollment Customer Inquiry, Telephone Reopening Unit and [...]

CMS to Begin Using MFA Process for Online Provider Enrollment System Applications

CMS to Begin Using MFA Process for Online Provider Enrollment System Applications CMS recently announced they will begin utilizing a MFA process for users of their Provider Enrollment Systems. MFA is a second layer of security used to [...]

Credit Balance Report - CMS 838 (R3)

Chapter VII: Online Reports View Submenu (04) Credit Balance Report - CMS 838 (R3) Purpose Credit balance reporting is used to certify whether you have any outstanding monies owed to the Medicare Program. Part A providers submit credit [...]

Do hospitals bill a different CPT to receive compensation? Usually, the doctor’s office will bill 27096 on 1500 and we bill G0260 for facility claim (UB-04). Will PA need to have both CPTs? 27096 on Medicare fee schedule receives no compensation?

There is a contrast shortage. Use may not be an option.

Do we use the same billing guideline for 64550 and 20551?

If using steroid during diagnostic is that when the 12-month clock start?

If a patient fails an initial diagnostic or therapeutic injection is there a certain criteria that must be fulfilled prior to considering it again, such as duration since the last injection (like over a year ago) or change in symptom character or location?

Can the patient can have two diagnostic SIJI and then four therapeutic SIJI within a 12-month rolling period for a total of six per year?

What is the time period between a therapeutic injection and repeat diagnostic, if the therapeutic injection has not been performed for an extended period? At this point, does diagnostic need to be repeated?

What is the purpose of a diagnostic injection, to select patients for fusion surgery only? Also, with diagnostic injections using anesthetic and steroid, what is the duration of effect expected for the steroid?

Do we use the KX modifier on facility charges for the ASC?

It does not make sense to use steroids during a diagnostic injection. Please explain.

Does anti-inflammatory steroid as named in the diagnostic injection mean an injected NSAID or corticosteroid?

What is the time period between a therapeutic injection and repeat diagnostic? If the therapeutic injection has not been performed for an extended period of time does diagnostic need to be repeated?