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Posting Date: 02/02/2021
Submit an Appeal Electronically with NGSConnex
Submit an Appeal Electronically with NGSConnex You can submit redetermination or reopening requests electronically through NGSConnex. To determine if your appeal qualifies as a reopening or redetermination, access the About Appeals page. All [...]
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Posting Date: 02/02/2021
Submit an Appeal Electronically via esMD
Submit an Appeal Electronically via esMD CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD. Some [...]
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Posting Date: 02/02/2021
Get Help Submitting a Appeal Hard Copy
Get Help Submitting a Appeal Hard Copy All levels of appeals may be submitted by mail. The only types of appeals submitted to National Government Services are reopening and redetermination requests. For information on other types of appeals, [...]
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Posting Date: 12/15/2021
How to Avoid Costly Appeals
How to Avoid Costly Appeals This table includes helpful information to help avoid costly appeals. Use the initial submission tips and resources to help reduce claim denials and improve revenue cycle workflow issues within your office. [...]
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Posting Date: 05/03/2022
How to Prevent Duplicate Appeal and Clerical Error Reopening Requests in NGSConnex
How to Prevent Duplicate Appeal and Clerical Error Reopening Requests in NGSConnex Do you currently submit your appeal requests and reopening requests through NGSConnex? If so, did you know you are required to verify whether a request was [...]
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Posting Date: 01/18/2022
Five Levels of Appeals
Levels of Appeals and Time Limits for Filing Table of Contents Five Levels of Appeals: Overview Level One – Redetermination Level Two – Reconsideration (QIC) Level Three – Administrative Law Judge (ALJ) Level Four – Medicare [...]
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Posting Date: 06/06/2023
Medical Review Portal in NGSConnex
Medical Review Portal in NGSConnex If you submit fee-for-service claims to National Government Services and you are a registered NGSConnex account holder, you can respond to Medical Review ADRs and submit supporting documentation [...]
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Posting Date: 06/06/2023
Medical Documentation Signature Requirements
Medical Documentation Signature Requirements Table of Contents Medical Documentation Signature Requirements Missing Signature Illegible Signature Signatures for Amendments, Corrections and Delayed Entries Related Content [Return to [...]
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Posting Date: 06/06/2023
Address Corrections for Providers
Address Corrections for Providers An ADR is sent to the provider’s or physician’s address that is listed in PECOS. This is the last address that was submitted to the MAC’s Provider Enrollment Department and approved by CMS. Questions [...]
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Posting Date: 06/06/2023
Additional Developmental Request Letters Overview
Additional Development Request Letters Overview National Government Services may require additional information in order to appropriately process claims submitted to the Medicare Program. These requests for additional information letters are [...]
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Posting Date: 06/06/2023
How to Find and Respond to TPE ADR
How to Find and Respond to TPE ADR Once you receive notification your facility is being placed on medical review, you’ll receive instructions on how to find the ADR. The ADR is a request to submit documentation for review to ensure proper [...]
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Posting Date: 06/06/2023
Results Letters
Results Letters After National Government Services reviews the requested claims for your facility/office, you’ll receive a Results Letter with results from that round of TPE review. The Results Letter will contain the number of claims that [...]
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Posting Date: 11/25/2024
LCD and Article Updates for November 2024
LCD and Article Updates for November 2024 Local Coverage Determinations and Billing and Coding Articles The following Local Coverage Determinations and Billing and Coding Articles have been finalized and will become effective on the specific [...]
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Posting Date: 12/02/2024
Get Help Completing My Enrollment Application
Since your organization can apply for Medicare enrollment in two ways, online through the PECOS system and on paper, it is important to know where to go to learn about the expected processes and guidelines. There are two main areas where you [...]
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Posting Date: 12/02/2024
Get Help Completing My Enrollment Application
Since your organization can apply for Medicare enrollment in two ways, online through the PECOS system and on paper, it is important to know where to go to learn about the expected processes and guidelines. There are two main areas where you [...]
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Posting Date: 10/24/2018
Initiate Part B Reopenings or Non-MSP Overpayment Adjustments in NGSConnex
Initiate Part B Reopenings or Non-MSP Overpayment Adjustments in NGSConnex Did you know that you can save time and money by requesting a Part B clerical error reopening electronically via NGSConnex? You will save time because electronic [...]
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Posting Date: 07/01/2024
17729 and 17730 Hospice Claim Edits for Certifying Physicians
17729 and 17730 Hospice Claim Edits for Certifying Physicians Effective for hospice claims with claim ‘From’ dates on or after 6/3/2024, new claim edits have been implemented per CR 13342 to enforce CMS’ rule to deny hospice claims if the name [...]
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Posting Date: 10/19/2021
How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B
How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B Table of Contents Determine if the Provider Has an Active Enrollment How to Enroll the Provider in Medicare Part B [Return to Top] Determine [...]
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Posting Date: 12/02/2024
Get Help Completing My Enrollment Application
Since your organization can apply for Medicare enrollment in two ways, online through the PECOS system and on paper, it is important to know where to go to learn about the expected processes and guidelines. There are two main areas where you [...]
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