Applying for an Extended Repayment Schedule

DRG (Pricer/Grouper) (11)

Chapter IV: Inquiries Submenu (01) DRG (Pricer/Grouper) (11) Purpose This option will be used by the provider to research PPS information as it pertains to an inpatient stay. To access the DRG (Pricer/Grouper) option from the FISS Online [...]

RSNAT Pre-Pay Review

RSNAT Pre-Pay Review The RSNAT PA program has two components, PAR or prepayment review, which suppliers are able to use their discretion on the path that best suits their workflow. If a RSNAT supplier chooses to forgo the PA process for [...]

Billing and Coding Article Update for August 2023

Billing and Coding Article Update for August 2023 Billing and Coding: Non-Invasive Vascular Studies (A56758) Effective 8/31/2023, the following ICD-10-CM codes were added to the "ICD-10-CM Codes That Support Medical Necessity" section (Group [...]

MLN Connects® Newsletter: August 24, 2023

MLN Connects® Newsletter: August 24, 2023 News Seasonal Flu Vaccine Pricing for 2023–2024 Season Expanded Home Health Value-Based Purchasing Model: July 2023 Interim Performance Reports, Post-Event Materials, & Comment on CY 2024 [...]

Unprocessable Claim Rejections and Corrections

Unprocessable Claim Rejections and Corrections Assigned and nonassigned services are considered unprocessable when incomplete or invalid information is detected in our claims processing system. Unprocessable claim is described in the CMS IOM [...]

Medicare Beneficiary Eligibility Checklist

Tip Sheet #1

National Government Services Office of Congressional Affairs Protocol: Tip Sheet #1 Medicare is changing and we live in a MAC world and this protocol explains the process to help you submit your Medicare constituent inquiries. Today, [...]

Multi-Factor Authentication

Multi-Factor Authentication Multi-factor authentication (MFA) is a second layer of security required by CMS to have online access to protected health information. The MFA screen will display every time you log in to NGSConnex. Each day [...]

View Remittance

View Remittance If you receive SPRs you will not be able to view remittance statements in NGSConnex. If you are signed up to receive an 835 ERAs or you have elected to view remittance statements through NGSConnex, you may view and print or [...]

Processing Drivers and System Claim Paths

Chapter I: Online System Terminology   Processing Drivers and System Claim Paths Purpose Claims that are filed through the FISS DDE Provider Online System follow a prescribed route referred to as a system claim path. Claim paths [...]

Claim Status and Location Codes

Chapter I: Online System Terminology Claim Status and Location Codes Purpose The purpose of the status and location is to route claims through FISS. The status describes the general condition of the claim (i.e., whether paid, denied, [...]

Main Menu

Chapter II: Online Menu Functions Overview FISS/DDE Main Menu Purpose The FISS/DDE MAIN MENU offers the following four submenu options: 01 – Inquiries 02 – Claims/Attachments 03 – Claims Correction 04 – Online Reports View [...]

Inquiries Submenu

Chapter II: Online Menu Functions Overview Inquiries Submenu Purpose The INQUIRIES submenu allows providers to perform research through various file options, such as the following: Beneficiary/CWF information Claim status DRG [...]

HCPCS Codes (14)

Chapter IV: Inquiries Submenu (01) HCPCS Codes (14) Purpose The purpose of the HCPC CODES option is to provide access to details related to the HCPCS codes available to be reported on a claim. HCPCS codes are five-digit alphanumeric [...]

DX/Proc Codes ICD-9 (15)

Chapter IV: Inquiries Submenu (01) DX/Proc Codes ICD-9 (15) Purpose The purpose of the DX/PROC CODES ICD-9 option is to provide a reference of ICD-9-CM code(s) used to identify a specific or various diagnosis codes or inpatient surgical [...]

Adjustment Reason Codes (16)

Chapter IV: Inquiries Submenu (01) Adjustment Reason Codes (16) Purpose An adjustment reason code is a two-digit alphanumeric code reported on a claim adjustment to identify the specific reason the claim is being adjusted. This option [...]

Reason Codes (17)

Chapter IV: Inquiries Submenu (01) Reason Codes (17) Purpose FISS reason codes are five-digit alphanumeric codes that indicate the outcome of claim editing and processing. The REASON CODE option provides details to indicate why the claim [...]

Claim Count Summary (56)

Chapter IV: Inquiries Submenu (01) Claim Count Summary (56) Purpose The CLAIM COUNT SUMMARY option provides a review of the total claim count and total dollar amount for claims pending in a specific location. This information is updated in [...]

Invoice Number/DCN Translator (88)

Chapter IV: Inquiries Submenu (01) Invoice Number/DCN Translator (88) Purpose The purpose of the Invoice Number/DCN Translator screen is to allow the provider to identify a claim’s Invoice Number when the DCN is known. This option also [...]