Check Provider Enrollment Application Status

Check Provider Enrollment Application Status You may run simple search queries to retrieve and view the status of your CMS-855 application via two options. Case number/web tracker id NPI and TIN combination Related Content Check [...]

Interactive Voice Response System

Interactive Voice Response System You may check the status of your provider enrollment application (PECOS or paper) submissions via the IVR by: Case number/web tracker id or NPI and TIN combination Related Content Part B Provider [...]

Approval or Denial

Approval or Denial Approval Once your application is approved, you will receive an email containing a Medicare Letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: CustomerService-DoNotReply@cms.hhs.gov containing the PECOS web tracking number. [...]

Physicians and Nonphysician Practitioners that Reassign All Benefits

Physicians and Nonphysician Practitioners that Reassign All Benefits Download CMS-855I. Complete Sections: 1, 2, 3, 4, 4F, 12, 13 and 15B Note: Submit national board certification and diploma for nonphysician practitioners. If adding [...]

Unnecessary Adjustments for Part B Claims

Unnecessary Adjustments for Part B Claims A recent transition process at the Medicare Part B system maintainer has resulted in unnecessary and inappropriate Part B claim adjustments, impacting all MACs nationwide. This issue started to occur [...]

Incident to Quick Reference Chart

Incident to Quick Reference Chart Location PT Status Scenario Who Bills Comments Office New patient NPP sees patient - MD not present in office suite NPP bills for the service under the NPP NPI NPP [...]

“Incident to” Services

“Incident to” Services This article has been specially designed for our providers who perform services “Incident to” the services of a physician/NPP. Table of Contents The “Incident to” Provision of Medicare Your Office Hospital or [...]

Supplemental Security Income Ratio Realignment for Cost Reporting Periods Starting Before 10/1/2013

Supplemental Security Income Ratio Realignment for Cost Reporting Periods Starting Before 10/1/2013 On 6/9/2023, in response to the Supreme Court’s ruling in Azar v. Allina Health Services, 139 S. Ct. 1804 (2019), the CMS issued a final rule [...]

Education Partnership Request Form

Education Partnership Request Form

Education Partnership Request Form

Education Partnership Request Form

MLN Connects® Newsletter: August 8, 2024

MLN Connects® Newsletter: August 8, 2024 Final Payment Rule Hospital Inpatient Prospective Payment System & Long-Term Care Hospital Prospective Payment System FY 2025 Final Rule News Transitional Coverage for Emerging Technologies [...]

Removal of Facet HCPCS Codes

Removal of Facet HCPCS Codes Prior Authorization Outpatient Department Update  Effective 8/16/2024, the CMS is removing two current procedural terminology codes from the OPD Facet Joint Injection list of codes: 64492 – Facet joint [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be directed to the Provider [...]

Medical Policy Contact Information

Medical Policy Contact Information Please Note: General inquiries related to Medicare coverage policies, including clinical issues, drugs, radiopharmaceuticals, local and national coverage determinations, billing and reimbursement must be [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)

Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations) If you disagree with Medicare’s claim determination, you may Appeal. However, please follow these important tips before you submit a first level of appeal [...]

Medicare Bad Debts

Table of Contents Review Medicare Bad Debt Listing Identifying Non-Allowable Fee Schedule Services Fee Schedules Included in Bad Debt Policy Medicare Bad Debts Related Content [Return to Top] Review Medicare Bad Debt Listing [...]

Monoclonal Antibodies in Treatment of Alzheimer’s Disease - Medicare Advantage Plan Responsibility

Monoclonal Antibodies in Treatment of Alzheimer’s Disease - Medicare Advantage Plan Responsibility NCD 200.3 was issued by CMS in April,2022 and outlines Medicare coverage policy for monoclonal antibodies that target amyloid (or plaque) for [...]

HETS EDI Enrollment Form User Guide

The HETS ​​​​​​EDI Enrollment Form allows providers to attest their relationship with a 3rd party entity to exchange the ANSI X12 270/271 Beneficiary Eligibility transaction on their behalf. Table of Contents Step 1 – Authorization [...]

HETS EDI Enrollment Form

Telehealth Place of Service 02 and 10 Clarification

Telehealth Place of Service 02 and 10 Clarification National Government Services has been receiving inquiries from providers in regard to POS 02 and POS 10 for telehealth service reporting. We’ve created this article to provide clarification. [...]

CLIA Number Processing Issue

CLIA Number Processing Issue National Government Services has been made aware of an issue with CLIA lab claims processing. CLIA numbers were not loaded through CWF, resulting in claim denials as CLIA did not match any file. We were informed [...]

Home Health Documentation Checklist

Home Health Documentation

State License and Registrations for Certified Providers and Suppliers

State License and Registrations for Certified Providers and Suppliers Prior to submitting a provider enrollment application to Medicare, ensure that all applicable state requirements are met for your provider type. Each state has unique [...]

Eligible Institutional Providers

Eligible Institutional Providers Certified Providers and Certified Suppliers that Enroll via the Form CMS-855A. Unique statutory and regulatory requirements for these types of providers/suppliers are addressed in the CMS IOM Publication [...]

MLN Connects® Newsletter: August 15, 2024

MLN Connects® Newsletter: August 15, 2024 News Negotiating for Lower Drug Prices Works, Saves Billions Resources & Flexibilities to Assist with the Public Health Emergency in Florida, Georgia, and South Carolina Hospitals: New EMTALA [...]

Additional Development Requests for Part A Claims for CPT J9299

Additional Development Requests for Part A Claims for CPT J9299 A system error on 7/25/2024 caused ADR letters to be issued in error on Part A claims for CPT J9299 with DOS on or after 3/1/2024. The issue has been resolved and all impacted [...]

End-Stage Renal Disease: Medicare Part A Quick Reference Manual

End-Stage Renal Disease: Medicare Part A Quick Reference Manual Table of Contents ESRD Provider PTAN Number Range: Third through sixth digit FL 04 Type of Bill FL 6 Statement Covers Period FL 18-28 Condition Codes FL 18-28 Condition [...]

Claim Submission Guidelines

Claim Submission Guidelines CMS developed and transmitted HCPCS and PFS payment and coding files to include revisions to add other CDT codes and indicated parameters for payment to implement the finalized Medicare Parts A and B payment for [...]

Disproportionate Share Hospital

The Medicare DSH adjustment provision under Section 1886(d) (5) (F) of the Act was enacted by section 9105 of the COBRA of 1985 and became effective for discharges occurring on or after 5/1/1986. According to section 1886(d) (5) (F) of the Act, [...]

Electronically Submitted Claims that Exceed $99,999.99 Reminder

Electronically Submitted Claims that Exceed $99,999.99 Reminder Electronically submitted claims containing a dollar amount in excess of 99,999.99 will be rejected as a front-end EDI edit. The Standard Companion Guide for Health Care Claim: [...]

MLN Connects® Newsletter: August 22, 2024

MLN Connects® Newsletter: August 22, 2024 News Commemorating the 2nd Anniversary of the Lower Cost Prescription Drug Law MolDx Local Coverage Determination Statement Hospital Price Transparency: Get Resources to Help You Comply New [...]

Facet Joint Interventions

Facet Joint Interventions National Government Services will begin accepting PARs for Facet Joint Intervention codes on 6/15/2023 for services provided beginning on or after 7/1/2023.   To meet coverage criteria, the patient’s medical [...]