NGS Medical Review Process

NGS Medical Review Process Medicare contractors, like NGS, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. Medical reviews involve the collection and clinical review of medical records and [...]

MLN Connects® Newsletter: May 29, 2025

MLN Connects® Newsletter: May 29, 2025 News Inpatient Hospital Admissions: Transferring Medical Review Responsibilities for Short Stay Claims Medicare Shared Savings Program: Apply Now MLN Matters® Articles National Coverage [...]

Medicare Review Contractors

During this webinar, we'll assist Medicare providers with knowing the difference between the Medicare review contractors and understanding their role in the Medicare review process. We'll discuss the Supplemental Medical Review [...]

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers

Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers Please see the below for information related to the CHOPD Accelerated and Advance Payments for Part A Providers and [...]

New Version of PC-ACE: January 2025

New Version of PC-ACE: January 2025 PC-ACE Version 6.5 contains several CMS mandates and product enhancements including but not limited to the items listed below. Change Request (CR) 13794 - Combined Common Edits/Enhancements Modules [...]

Electronic Health Records

Electronic Health Records Eligible professionals under the Medicare EHR Incentive Program include: Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor If [...]

HETS EDI Recertification

Tutorial

Medicare Claims: CMS-1500 or Electronic

Requesting an Exception to Timely Filing

Requesting an Exception to Timely Filing Table of Contents Requesting an Exception to Timely Filing No Appeal Rights for Claims Denied Based on Timely Filing Limit Provider Liability Exceptions that May Allow the Time Limit to be [...]

Targeted Probe and Educate Educational Videos

Targeted Probe and Educate Educational Videos Video Description MAC Medical Review Best Practices: Updating Your Contact Information Did you know providers can now designate a separate [...]

Let's Chat About Medicare Secondary Payer

During this session, you’ll have the opportunity to ask questions about all aspects of Medicare Secondary Payer. Answers will be provided by a panel of subject-matter experts. As this is a question-and-answer session, there is no presentation [...]

Medical Review: Targeted Probe and Educate Review Topics

Medical Review: Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to [...]

Observance of Juneteenth Holiday

Observance of Juneteenth Holiday In observance of Juneteenth, the National Government Services offices will be closed on Thursday, 6/19/2025. This includes the following departments: EDI Help Desk* Provider Contact Center Provider [...]

Some Claims Editing for Reason Code U537I, HH Claim Falls Outside of an HH Admission Period for the Same Provider

Note: This issue was originally reported and resolved in April 2025. The issue has returned so we have reopened the alert. The CWF can only hold the 36 most recent periods of care for any beneficiary. CWF also contains the indicator of when [...]

Resources

MLN® Fact Sheet: Medicare Overpayments CMS Internet-Only Manual Publication 100-06, Medicare Financial Management Manual, Chapter 3 - Overpayments Reviewed 6/4/2025

Overpayment Request

Table of Contents Forms You'll Need Large Scale Overpayments Overpayment Notification Process Timeline for Processing a Demand Letter [Return to Top] Forms You'll Need Forms for non MSP-related are generally done via NGSConnex, but [...]