Using Provider Self-Service  

We frequently receive comments through our customer experience surveys that providers would prefer to talk directly with a live customer care representative to have their questions answered. CMS requires all MACs to offer provider self-service tools.  While we understand your preference to talk with a live representative, we ask for your patience in understanding that CMS does not permit representatives to answer some questions when that answer can be obtained through self-service.

Customer care representatives are available during regular business hours to assist you with a wide-range of Medicare coverage and billing-related inquiries.

Customer care representatives can assist with:

• • clarifying why a claim processed the way it did,
  • general Medicare information/billing questions,
  • guidance for using the IVR system and the website and
  • complex issues that cannot be addressed through the use of self-service options.

Customer care representatives are not permitted to provide:

• • elements listed below that can be obtained through the IVR,
  • coding guidance for what modifier, diagnosis code, CPT code or HCPCS code to use for specific claims or beneficiaries and
  • preauthorization for any type of service or supply.

The Interactive Voice Response System

The IVR is accessed through separate numbers than the live representatives in our Provider Contact Center. The IVR is available 24 hours a day, 7 days a week, giving you access to the information when you need it. The IVR uses natural language and text-to-speech technology that responds to your voice, touch tone is also available and provides information for:

• • patient eligibility,
  • claim status,
  • checks,
  • offsets,
  • pricing,
  • provider enrollment,
  • appeal status and
  • general information.

With the complex nature of the alpha-numeric information that needs to be provided to the IVR, e.g., the MBI, it is highly recommended to use the phonetic alphabet when speaking this type of information.  When speaking an alpha character, please use the either the military word or the common word in the phonetic alphabet provided below (also available in the IVR user guides). For example, if the MBI is 1EG4-TE5-MK73, you will speak the following in the IVR, “1 Echo Golf 4 Tango Echo 5 Mike Kilo 7 3.”

Tips for Using the Phonetic Alphabet

• • Do not say things like “A as in Apple”; if there is an A, just say “Alpha” or “Apple.”
  • Do not use other words. Only use the words provided.
  • You can use the military or the common words provided. You can mix and match throughout speaking the information.
  • Note: The MBI does not contain S, L, O, I, B and Z.

Find your IVR phone number and more details on our website under Contact Us > Interactive Voice Response.  You can also view the IVR User Guide for Part A or Part B in this section of our website.

 NGSConnex 

NGSConnex is our Internet self-service portal that allows you access to a wide array of information and features such as:

• • beneficiary eligibility and entitlement information,
  • query for your claims status,
  • view your provider/supplier demographic information,
  • query for your financial data,
  • view and print your remittance advice and
  • submit an online inquiry.

Register for NGSConnex and take advantage of the many tools it offers. Visit our NGSConnex informational web page for details.

We review every comment and suggestion we receive on the MCE survey. Although we can’t implement all suggestions, we appreciate every response. When you visit our website and the survey displays, please consider choosing, “Yes, I’ll help”.

Posted 5/6/2021