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When to Use the Provider Contact Center Versus Self-Service Tools

The CMS requires contractors to provide self-service and electronic communication technologies as efficient, cost effective means of disseminating Medicare provider information, education, and assistance. To fully comply with this requirement, National Government Services requires providers to use these tools as appropriate. NGS’s self-service tools consist of the NGSConnex provider portal and the Interactive Voice Response System.

If you contact the PCC and the information you are requesting is available via NGSConnex or the IVR, the PCC is required to direct you to NGSConnex or the IVR to obtain the information. The CSRs in the PCC are available to assist you with more complex inquiries that require extra time and attention.

Note: Providers are responsible for determining the correct diagnostic and procedural coding for the services they furnish to Medicare beneficiaries. CSRs shall not make determinations about the proper use of codes for the provider.

When inquiring about interpretation of procedural and diagnostic coding, providers shall refer to the entities responsible for those coding sets. You may reference this information in CMS Internet-Only Manual, Publication 100-09, Medicare Administrative Contractor (MAC) Beneficiary and Provider Communications Manual, Chapter 6, Section 30.3.1.

NGSConnex

NGSConnex is a free, secure, web-based application. NGSConnex provides access to a wide array of self- service functions that can be found in the NGSConnex User Guide. Some of the self-service transactions you are able to complete in NGSConnex are:

  • Eligibility
    • Effective dates
    • Current and past year deductibles; including therapy
    • Preventive services
    • Inpatient spell history
    • Medicare secondary payer and Medicare Advantage plan
    • Crossover
    • COVID-19 vaccine
  • Claims
    • Submit a claim
    • Overlapping/duplicate claim search
    • Claim search
    • View claim status, claim denials
    • Initiate redetermination/reopening requests, check status and view redetermination decision letters
    • View/print remittance – if you are signed up to receive electronic remittance advice (ERA) statements or have elected to view remittance statements in NGSConnex
    • Respond to Medical Review additional documentation requests (ADRs)
  • Financial
    • View outstanding overpayments
    • Initiate check search
    • View check information
    • View provider earnings year to date
    • View financial claim number information
  • Appeals/Reopenings
    • Initiate search for redetermination/reopening requests submitted via NGSConnex under your user ID
    • View and save redetermination attachments submitted via NGSConnex under your user ID
  • Initiate an Inquiry Related to:
    • NGSConnex
    • General (not claim specific)
    • HiServ
    • Medical Review
    • Medicare claim

Interactive Voice Response

The IVR is maintained on a separate line from the PCC. The IVR is available 24 hours a day, seven days a week. Menu options that require system access (e.g., the Common Working File) are limited to that systems availability. The IVR provides access to a wide array of self- service functions that can be found in the IVR User Guide. Some of the self-service transactions you are able to complete in the IVR are:

  • Eligibility
    • Medicare effective/termination dates, including the QMB program
    • Current and past year deductible information, including therapy
    • Medicare secondary payer and Medicare Advantage plan information
    • Home health and hospice enrollment periods
  • Claim Status
    • Full claim status including payment, overlap, crossover and duplicate denial information
  • Checks
    • Status of checks including; cashed, cancelled, voided. Outstanding, and earnings to date 
  • Offsets
    • Detailed information on the original and adjusted claim
  • Pricing
    • Fee schedule amounts for procedure codes entered
  • Provider Enrollment
    • Status of applications
  • Appeals
    • Status of redeterminations

View the Contact Us page to access the Part B IVR telephone number for your jurisdiction.

For information which cannot be found through the NGSConnex provider portal or the IVR, you may contact our PCC.

The PCC is able to:

  • Clarify the denial reason associated with a claim,
  • Provide general information regarding Medicare coverage and/or
  • Assist with other complex issues.

The PCC is unable to:

  • Provide claim status, beneficiary eligibility, or other information which is available through NGSConnex or the IVR.
  • Give preauthorization of beneficiary entitlement for specific DME.
  • Claim adjustments. For additional information review Reopenings for Minor Errors and Omissions.
  • Answer inquiries from beneficiaries or their representatives (please call 1.800.MEDICARE [800-633-4227]).

Before calling the PCC, you should take the following steps:

  • Consult your provider remittance advice. For additional information, view Remittance Advice.
  • For medical necessity and coverage issues, visit our Medical Policy Center for the appropriate LCD.
  • For general questions visit our website.

When calling PCC, you will be required to have the following information ready:

  • Your NPI number
  • Your PTAN, also known as your legacy number or NSC number.
  • The last five numbers of your TIN.
  • MBI or beneficiary’s HICN, name, date of service and/or date of birth, if appropriate.

The denial/rejection reason associated with a claim.

Published 6/23/2021

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