U5220

Avoiding/Correcting This Error Verify the MBI and date(s) of service. If services were provided prior to the date the beneficiary was entitled to Medicare, no further action is necessary. Otherwise, correct and resubmit.

U538Q

Avoiding/Correcting This Error Medicare does not pay for medical items/services furnished to an alien beneficiary who was not lawfully present in the United States on the date of service that the items/services were furnished. Related Content [...]

34293

Avoiding/Correcting This Error Review your beneficiary’s enrollment in a Medicare HMO/MAO prior to providing services. A beneficiary may drop MAO coverage; review the CWF, IVR, NGSConnex, or HETS to identify a termination date for the MAO [...]

3/13/2025 Part B POE Advisory Group Meeting

3/13/2025 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Doris Barnes, Aurelia Barraco, Brenda Bedard, Sheila Bembeneck, Madelon Berger, Todd Bergstrom, Kimberly Bischel, Mollie [...]

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 [...]

Meeting Minutes

Meeting Minutes Jurisdiction 6 Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Island, Oregon, Puerto Rico, U.S. Virgin Islands, Washington and Wisconsin [...]

[RESOLVED] NGS Phone Lines Currently Unavailable

[RESOLVED] NGS Phone Lines Experiencing Outages The outages we were experiencing with our Provider Contact Center telephone lines have now been resolved. This includes EDI, Provider Enrollment Customer Inquiry, Telephone Reopening Unit and [...]

CMS to Begin Using MFA Process for Online Provider Enrollment System Applications

CMS to Begin Using MFA Process for Online Provider Enrollment System Applications CMS recently announced they will begin utilizing a MFA process for users of their Provider Enrollment Systems. MFA is a second layer of security used to [...]

Credit Balance Report - CMS 838 (R3)

Chapter VII: Online Reports View Submenu (04) Credit Balance Report - CMS 838 (R3) Purpose Credit balance reporting is used to certify whether you have any outstanding monies owed to the Medicare Program. Part A providers submit credit [...]

DDE: How do I get my log on ID password reset?

Telehealth Services

Telehealth Services Table of Contents General Information Originating Site Distant Site List of Covered Medicare Telehealth Services Billing Facility Fee for Originating Site Payment for Professional Fee Place of [...]

Telehealth Extension 2025

Telehealth Extension 2025 A Congressional continuing resolution bill has extended telehealth coverage for services in all U.S. geographic locations through 9/30/2025. Based on this guidance, National Government Services will continue to pay [...]

Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities

Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities The hospital is the entity required to bill POA indicators on all inpatient claims billed to Medicare. However, accurate coding of all diagnosis [...]

NCCI Lookup Tool Top

National Correct Coding Initiative Lookup Tool The NCCI PTP lookup tool is designed to help providers identify when certain codes are subject to the automated code pair edits. When two codes of an edit pair are identified, the major code [...]

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 [...]

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 [...]

32402

Avoiding/Correcting This Error Verify HCPCS code using the FISS DDE Inquiries HCPCS file (option 14) to determine the allowable revenue codes based upon the date of service. Verify billing and, if appropriate, correct the claim using the [...]