New Provider Center
National Government Services: A Medicare Administrative Contractor – Who Are We?
A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries in a defined geographic area(s). In the United States, there are 12 MAC jurisdictions. NGS serves as the Part A and Part B MAC for 2 of those jurisdictions, Jurisdiction K (CT, MA, ME, NH, NY, RI, VT) and Jurisdiction 6 (IL, MN, WI).
NGS serves as the Home Health and Hospice MAC for Jurisdiction K (CT, MA, ME, NH, RI, VT) and Jurisdiction 6 (NY, NJ, MI, WI, MN, ID, NV, WA, OR, CA, AZ, AK, HI, PR, Mariana Islands, American Samoa, Virgin Islands, Guam) and federally qualified health centers and rural health clinics in 44 states, District of Columbia and 5 U.S. territories.
As a MAC, NGS is responsible for all aspects of claim processing in these geographic locations, including claim development for additional information, claim review, first level of appeal for claim denials and both underpayment and overpayment collection processes. NGS also effectuates claim review decisions on behalf of other CMS-authorized contractors such as CERT and the RAC based on findings in their independent claim review activities. NGS is responsible for the full scope of provider education and communication needed for new and experienced Medicare providers, keeping them informed of new and changing guidelines for the Medicare program. Visit About Us to learn more.
National Government Services Guide for New Providers
The NGS PEX staff welcomes you to Medicare. Providers are responsible for knowing and following the rules and regulations that apply to all services billed to Medicare under their provider number. NGS offers a variety of provider self-service tools. We also provide education tailored to the needs of new Medicare providers and their billing staff, including information that outlines fundamental Medicare policies, programs, procedures, Medicare billing and how to use self-service tools.
In addition to the resources listed below, we developed the NGS Guide for New Providers which is emailed to new providers upon approval of enrollment. This comprehensive guide is designed to assist new providers in understanding the Medicare Program and offers direct links to NGS resources. Please share this guide with your office and billing staff.
Table of Contents
- Introduction to Self-Service Tools and Education for New Providers
- Provider Self-Service Tools
- Immediate Recoupment of Medicare Overpayments
- CMS Website Links
- Educational Offerings
Introduction to Self-Service Tools and Education for New Providers
National Government Services offers a variety of provider self-service tools. We also provide education tailored to the needs of new Medicare providers and their billing staff, including information that outlines fundamental Medicare policies, programs, procedures, Medicare billing and how to use self-service tools.
Provider Self-Service Tools
NGSConnex.com: Online Access to Medicare Transactions That Can Save Time & Money!
NGSConnex is our online self-service portal that allows you to access and submit information in a secure, protected environment. Every new provider or their staff should register to take advantage of all the features offered including beneficiary eligibility, claim status, financial information, appeal and inquiry submissions to name a few. To learn more about creating an account and using NGSConnex, select Education > Manuals > NGSConnex User Guide or visit our YouTube channel.
Interactive Voice Response System
The IVR is available 24 hours a day, seven days a week (though some transactions are limited based on other system’s availability). You will use the IVR to obtain information such as patient eligibility, claim status, deductibles, check information, and other general information. Find your IVR phone number on our website, select Resources > Contact Us > Interactive Voice Response System.
NGSMedicare.com
Our website contains the instructions, information and tools you need for to do business with us.
Email Updates
NGS maintains a free electronic mailing list to notify you via email of all changes and important, time sensitive Medicare information. Sign up for our Email Updates program today by selecting Subscribe for Email Updates at the top of our website.
Medical Policies/LCDs
Our Medicare Policies section contains information about various coverage statements. New providers should be aware of NGS’ LCDs and CMS NCDs. Select Resources > Medical Policies/LCDs to access this section of our website.
Electronic Data Interchange
Providers are required to submit claims electronically with limited exceptions. Providers are also encouraged to sign up to receive ERA notices. To access enrollment information for electronic products and services, please select Resources > EDI Enrollment.
Immediate Recoupment of Medicare Overpayments
Providers are encouraged to submit a one-time request for permanent immediate recoupment of any future Medicare overpayments. This allows NGS to deduct the overpayment amount from future payments for approved to pay claims. This also avoids interest accrual as long as the overpayment is satisfied by the due date. To learn more, select Resources > Overpayment > Request an Immediate Recoupment.
CMS Website Links
As a newly-certified provider, we encourage you to visit the CMS website to access more resources. You can obtain direct links from our website to important CMS resources by selecting Education > Help and FAQs > CMS Helpful Links.
Educational Offerings
YouTube
The NGS YouTube channel provides educational videos for Medicare providers. Enjoy a number of informational YouTube videos published by NGS and CMS including videos on Medicare University, NGSConnex and much more on our YouTube Channel.
Training Events
NGS offers educational events throughout the year. All upcoming events can be found in the Events section of our website. New providers and recently hired billing staff should check this section often.
Medicare Topics and Specialties
Review a wide selection of educational resources developed by NGS as well as access to key resources on other Medicare-related sites. Under Education, refer to Specialties, Medicare Topics or Manuals and Guides. We recommend these great resources for new providers.
Medicare University
NGS developed CBT courses in our self-paced education portal, Medicare University. MU allows you to complete courses at your own pace when it's convenient for you. You can access MU directly at Medicare University or by selecting the Medicare University link found in the Apps section of our website.
Revised 4/4/2024