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Posting Date: 04/25/2025
(CORRECTION) Some Claims Editing for Reason Code U537I, HH Claim Falls Outside of an HH Admission Period for the Same Provider
The CWF can only hold the 36 most recent periods of care for any beneficiary. CWF also contains the indicator of when the HH admission (NOA) was processed. This indicator allows CWF to determine whether an HH admission period is on file with [...]
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Posting Date: 04/25/2025
Acute Care Hospitals: Advance Beneficiary Notice of Noncoverage (CMS-R-131 Form) for Outpatient Services
Acute care hospitals: Do you understand when and how to issue an Advance Beneficiary Notice of Noncoverage (ABN) for outpatient services? Join this session to learn more about the voluntary and mandatory ABN, three payment liability conditions, [...]
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Posting Date: 04/08/2025
New Version of PC-ACE: April 2025
New Version of PC-ACE: April 2025 PC-ACE Version 6.6 contains several CMS mandates and product enhancements including but not limited to the items listed below. 13891 – Implement Operating Rules – Phase III Electronic Remittance Advice [...]
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Posting Date: 05/25/2022
Illinois, Minnesota, Wisconsin
Member Name Group Email Aldrich, Elizabeth IPW (Independent Physicians of Wisconsin), Allen Family Practice ealdrich@ipw-offices.org Anderson, Benita Aurora Health Care Benita.Anderson@aurora.org [...]
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Posting Date: 05/12/2023
NGSConnex: Initiating and Checking Status of Reconsiderations
Did you know that you can save time and money by requesting a reconsideration via NGSConnex? When you submit reconsideration requests electronically using NGSConnex, you no longer need to complete a form, copy documentation and waste time with [...]
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Posting Date: 06/07/2024
Exemption Process for the Prior Authorization Program for Certain Hospital Outpatient Department Services
The Centers for Medicare & Medicaid Services (CMS) implemented a prior authorization program for certain hospital outpatient department (OPD) services for date of service (DOS) on or after 7/1/2020 and subsequently added an exemption [...]
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Posting Date: 01/16/2025
Let’s Chat: Prior Authorization for Certain Hospital Outpatient Department Services
This Let’s Chat session focuses on Prior Authorization for certain hospital outpatient department (OPD) services and is an informal opportunity for you to chat with our staff about the selected topic. During the session, you may ask us [...]
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Posting Date: 01/13/2025
Prior Authorization for Certain Hospital Outpatient Department Services – General PA
Join us for this general webinar about Prior Authorization for certain Hospital Outpatient Department (OPD) services. This webinar will have a non-clinical focus with emphasis on general requirements as listed in the OPD Operational Guide.
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Posting Date: 02/26/2025
Provider Enrollment: Initially Enrolling a Dentist in the Medicare Program
During this webinar, we’ll address the Medicare dental specialty codes and provide an overview of how to enroll using Provider Enrollment, Chain and Ownership System (PECOS) as well as using the CMS-855I paper application. This session is [...]
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Posting Date: 02/19/2025
Submitting Revalidation via PECOS
During this webinar, we’ll provide an understanding of how to utilize the Centers for Medicare & Medicaid Services (CMS) Internet-based Provider Enrollment Chain & Ownership System (PECOS) to be comfortable in navigating the system to [...]
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