- Section 1 Introduction
- Introduction
- Federal Government Administration
- Fundamentals of Medicare: State Responsibilities
- Fundamentals of Medicare: Participating Providers
- Voluntary and Involuntary Termination of Provider Agreement
- Disclosure of Health Insurance Information
- Privacy Act
- National Provider Identifier
- Legacy Provider Numbers/Provider Transaction Access Numbers (PTANs)
- Medicare Administrative Contractors
- Fundamentals of Medicare: Information References
- Acronyms
- Fundamentals of Medicare: Glossary of Terms
- Section 2 Medicare Basics
- The History of Medicare
- What Is the Medicare Program and How Is It Funded?
- Medicare Eligibility and Premiums
- The Social Security Administration and Medicare Enrollment
- The Medicare Card
- Medicare Part A
- Inpatient Hospital Care
- Skilled Nursing Facility Inpatient Care
- Home Health Care Benefit
- The Hospice Benefit
- Medicare Part B Medical Insurance
- Fundamentals of Medicare - Medicare Program Exclusions
- Medicare Advantage Organizations
- Medicare Secondary Payer
- Supplemental Insurance
- Coordination of Benefits Trading Partners
- Section 3 Fraud and Abuse
- Section 4 Getting Ready to Bill Medicare
Section 1: Introduction
Information References
Table of Contents
Information References
National Government Services offers many great ways for providers to obtain information when they have questions or need assistance resolving an issue.
Telephone Inquiries
The customer care representatives are available during normal business hours to assist you by telephone with questions regarding your Medicare claims. Our provider contact center representatives handle an average of 14,000 calls per month; so, to make your call more productive, please make sure the following information is readily available before the call is placed if you have a claim-related question:
- Provider number
- NPI
- Last five digits of Federal Tax ID number
- Name of the patient
- HIC number of the patient
- Date of birth
- Dates of service in question
Interactive Voice Response
The IVR system will allow you to speak directly into the telephone instead of pushing buttons to make a selection when prompted. The information available will be patient eligibility, claim status, payment status, and other valuable information. The IVR must be used for basic information; a PCC representative will refer you to the IVR if your call is regarding basic information, e.g., beneficiary eligibility, etc.
Eligibility Information
Here you will find Part A and Part B effective and termination dates, the latest billing, and Part B deductibles. The number of hospital, SNF, and LTR days may also be obtained as well as information about MAOs, MSP, home health, and hospice care. All you need to do is provide the disclosure information required by law. The eligibility option has been modified to allow callers to change the date of service without having to re-enter the patient Medicare information. Please keep in mind, you’re not able to retrieve eligibility if the date of service is more than one year from the date you make the call.
You will need your provider number, your patient’s Medicare number, gender, first name, last name, and date of birth.
An after-hours greeting will remind you that you are calling outside of normal business hours, therefore the information you can obtain is limited. Eligibility and general information are the only options available 24-hours a day, seven days a week.
Claim Status Information
This option contains summary information such as receipt date, dates of service, type of bill, total charges, claim status and location, and DCN. You can select the claim you want details on and obtain FISS reason codes, provider reimbursement, deductible and coinsurance, liability of denied claims, total noncovered charges, check number and more! The patient status option has been modified to allow callers to request “next day” after receiving patient status information. This feature will quickly search patient status for the next sequential date of service without requiring the patient information to be reentered. The Part A Claims Details option has been updated to include pending dollar amount summary information. Have readily available and be prepared to enter your NPI, PTAN, and TIN. The IVR will provide the total number of claims, followed by the pending dollar amount.
You will need your provider number, your patient’s Medicare number, dates of service, and first and last name.
IVR will ask caller if they want to hear payment floor information. If they say yes, IVR will read back information. If they say no, IVR will go to claim summary information
Providers will be able to barge within Claims Summary by pressing 9 on telephone keypad will allow callers to move to navigation within Claims Summary to move on to next, previous or claim details, etc.
Providers are now able to obtain status of their provider enrollment application. This enhancement is intended to improve your experience when contacting the National Government Services Customer Care Department.
When calling for provider enrollment application status, please have the following information ready:
- Your case number (assigned to your PECOS enrollment submission), or
- Your NPI and TIN (or Social Security Number) associated with the NPI
All you need to do at the command prompt is to say “provider enrollment” or enter option 6 on the telephone keypad. You will then be prompted to provide your case number or your NPI and TIN.
Check and Remittance Information
In the check menu, you will be able to get information on a specific check date or the last three checks processed for your facility. In the remittance menu, you will be able to hear the breakdown of your payments and withholdings for a specific remittance date. You will need to be prepared give your provider number for check and remittance information.
Previously, if providers were terminated from Medicare, they could not access the IVR. The IVR would not recognize terminated NPI/PTAN/TIN. Now, terminated providers will be able to access IVR and have access to all menu options except Eligibility.
General Information
This selection includes a submenu that will offer you several choices, e.g., phone numbers, addresses, appeal rights, MAO information, ANSI code (shown on remittance advice) information and more!
Revised 1/2021