Corporate Holiday Schedule

Corporate Holiday Schedule The National Government Services Provider Contact Centers will be closed in 2025 to observe the following corporate holidays: Date Corporate Holiday Observed Wednesday, January 1, 2025 [...]

Quarterly Credit Balance Reports No Longer Required

Quarterly Credit Balance Reports No Longer Required As of 12/1/2024, providers are not required to submit the Medicare Credit Balance Report (CMS-838) on a quarterly basis. However, to ensure that monies owed to Medicare are repaid in a timely [...]

Submitting a Prior Authorization Request

Submitting a Prior Authorization Request Table of Contents Submitting a Prior Authorization Request Documentation Requirements Documentation Checklist for Medical Professionals Supporting the Physician Certification Statement [Return [...]

National Government Services - Telehealth Extension 2025

National Government Services - Telehealth Extension 2025 Section 3207 of the American Relief Act, 2025 modified Section 1834(m) of the Social Security Act to extend the waiver of the geographic, site of service, and practitioner type [...]

J6 Part A

J6 Part A Member Name Facility State Albaitis, Susan DaVita Kidney Care Multiple states (ESRD) Anderson, Brian Advocate Aurora Illinois Anderson, Keith Southern Illinois Healthcare [...]

Hospice Cap Self-Reporting Reminder for the 2024 Cap Year

Hospice Cap Self-Reporting Reminder for the 2024 Cap Year The Hospice Cap Self-Reporting for the 2024 Cap Year (10/1/2023–9/30/2024) is due no later than 2/28/2025. Hospice providers should submit the pro-forma calculation along with [...]

Hospice Cap Self-Reporting

Hospice Cap Self-Reporting Table of Contents Hospice Cap Self-Reporting Cap Year (10/1/XXXX–9/30/XXXX) Completing the Pro-Forma Submitting the Pro-Forma Repaying an Overpayment Requesting an Extended Repayment Plan [...]

Federally Qualified Health Center (All States)

Federally Qualified Health Center (All States) Member Name Facility State Banks, Amy Health Access Network, Inc. Maine Boyd-Gamson, Terry Santa Barbara County Public Health California [...]

Part A Content

Cost Report Contacts: IL, MN, WI, All FQHC: Bobbi Jo Luciano, Manager Office: South Portland, ME Sharon Townsend Office: South Portland, ME J6_Cost_Report_Filing@anthem.com Mailing Address for USPS: National Government Services Attn: Cost [...]

Part A Content

Cost Report Contacts: CT, ME, MA, NH, NY, RI, VT: Bobbi Jo Luciano, Manager Office: South Portland, ME Sharon Townsend Office: South Portland, ME JK_Cost_Report_Filing@anthem.com Mailing Address for USPS: National Government Services Attn: [...]

Clinicians: Are You Ordering Ankle-Foot/Knee-Ankle-Foot Orthoses for Your Patients?

Clinicians: Are You Ordering Ankle-Foot/Knee-Ankle-Foot Orthoses for Your Patients? The DME MACs are providing helpful guidance to assist suppliers in providing a lower limb orthosis to your patient. Medicare must be able to verify that there [...]

PA RSNAT Coversheet

Medicare Part A

Section 2: Medicare Basics Medicare Part A Table of Contents Medicare Part A Benefit Periods—Medicare Part A Ending a Benefit Period Benefit Period Examples [Return to Top] Medicare Part A Medicare Part A is referred to as Hospital [...]

Clinicians: Are You Ordering Knee Orthoses for Your Patients?

Clinicians: Are You Ordering Knee Orthoses for Your Patients? The DME MACs are providing helpful guidance to assist suppliers in providing a knee orthosis to your patient. Medicare must be able to verify that there is medical record [...]

MLN Connects® Newsletter: January 8, 2025

MLN Connects® Newsletter: January 8, 2025 News Medicare Part B Vaccine Administration: CY 2025 Payment Amounts Historically Excepted Tribal Federally Qualified Health Centers: CY 2025 Payment Rate DMEPOS: Adding New Product Category to [...]

Fourth Quarter Top Ten EDI Part B Edits

Fourth Quarter Top Ten EDI Part B Edits Using data analysis, we’ve updated the Top Ten EDI Edits for the 2024 fourth quarter. Visit Quarterly Top Ten EDI Part B Edits to view the edits, their description and learn what you can do to correct [...]

Helping Your Patients Stop Smoking

Helping Your Patients Stop Smoking Quitting tobacco use presents various challenges for patients, and staying motivated can be difficult. All health care providers, especially those with direct patient contact, have a unique opportunity to [...]

31605

Avoiding/Correcting This Error The occurrence span code 77 should only be used to indicate the span of days that were not covered on claims. Related Content Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77  

7C625

Avoiding/Correcting This Error Hospice – Clarify reason for discharge. Claim is being returned for one of the following reasons: Remarks are not present or do not indicate valid reason for discharge/transfer. Remarks indicate beneficiary [...]

37402

Avoiding/Correcting This Error Hospice – This error occurs when a claim is submitted and the previous month's claim has not been found in the system or there is a gap between Through date of the previous claim and From date on this claim. [...]

U5106

Avoiding/Correcting This Error When the hospice NOE was received it fell within a previously established election period. Verify that the NOE is billed with correct dates. If benefit period from the previous hospice is still open, allow [...]

U5194

Avoiding/Correcting This Error In instances where a NOE is not timely-filed, the days of hospice care from the hospice admission date to the date the NOE is submitted to and subsequently processed by the Medicare contractor will not be [...]

Jurisdiction 6 Part B Top Claim Errors Are Updated

Jurisdiction 6 Part B Top Claim Errors Are Updated Did you know we publish the top claim errors on our website? This resources provides detailed information including: the error reason code; a description of the error; the error type; [...]

U537F

Avoiding/Correcting This Error Always verify billing before submitting a new NOA for a beneficiary admission. There should not already be an NOA in the system pending processing or finalized prior to submitting a new NOA for a beneficiary. [...]

U5166

Avoiding/Correcting This Error If a transfer occurred, verify that all claims and notices are submitted in order. The transferring-from hospice agency needs to submit their final claim prior to the transferring-to hospice agency submitting [...]

37402

Avoiding/Correcting This Error Hospice – This error occurs when a claim is submitted and the previous month's claim has not been found in the system or there is a gap between Through date of the previous claim and From date on this claim. [...]

U5233

Avoiding/Correcting This Error Collect all insurance information from the beneficiary when admitted to your HHA. Talk to the beneficiary about insurance changes and check CWF before billing Medicare. Many times a claim will overlap an MAO [...]

U537F

Avoiding/Correcting This Error Always verify billing before submitting a new NOA for a beneficiary admission. There should not already be an NOA in the system pending processing or finalized prior to submitting a new NOA for a beneficiary. [...]

U5109

Avoiding/Correcting This Error When submitting a transaction to indicate the beneficiary’s election to revoke the hospice benefit, transfer the patient, cancel the election, or a change of ownership, the information on the transactional bill [...]

U5111

Avoiding/Correcting This Error Hospice – When submitting a hospice Notice of Termination/Revocation (TOB 8XB) or a Cancel Notice of Election (TOB 8XD) ensure that the From date on the transaction matches the Start date posted on CWF for that [...]

U5181

Avoiding/Correcting This Error Ensure the usage of an appropriate certification or recertification date in accordance with occurrence code 27. Related Content Avoiding Reason Code U5181: Appropriate Use of Occurrence Code 27/Occurrence [...]

38050

Avoiding/Correcting This Error Check your remittance advice or the claims processing system for a previously submitted/processed claim before submitting any new billing.

37364

Avoiding/Correcting This Error There was an issue with NOAs incorrectly editing for U537F. Once the system was fixed, NOAs could be resubmitted and subsequently processed. NOAs submitted late due to this issue may have affected more than one [...]

38031

Avoiding/Correcting This Error Verify the ‘from’ and ‘through’ dates, provider number, revenue codes, HCPCS codes, and line item date of service on the bill. If the claim is truly a duplicate; no action is necessary. Providers should develop [...]

38032

Avoiding/Correcting This Error Providers should develop and implement a process to ensure that duplicate claims are not being submitted. If the claim is truly a duplicate, no action is necessary. If this is not a duplicate and the provider [...]

38054

Avoiding/Correcting This Error Verify the claim history to determine the period of care claim that is causing the overlap If there are services that should have been included on a processed/paid claim, you must submit an adjustment (3X7 [...]

38055

Avoiding/Correcting This Error Verify the claim history using the FFS/DDE Provider Online system, your remittance advice and/or the CWF to determine the episode claim that is causing the overlap If there are services that should have been [...]

38200

Avoiding/Correcting This Error This reason code may be applied when an NOA and period of care claim are submitted at the same time or when an NOA and one is already in the system. If the NOA and claim were submitted at the same time, and no [...]

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Providers can see line details in NGSConnex and hover over the line item reason code(s) for [...]

39934

Avoiding/Correcting This Error You can find line level information by accessing MAP171D in the FISS/DDE Provider Online System: Hit <F2>/<PF2> once or <F11>/<PF11> twice from Claim Page 02 of the claim to access [...]

U5200

Avoiding/Correcting This Error Verify that the MBI on the claim is for the correct beneficiary. If the MBI is correct, verify the beneficiary’s entitlement information, correct, and resubmit if appropriate. If the MBI is incorrect, submit [...]

U5211

Avoiding/Correcting This Error Verify the MBI and dates of service. If appropriate, correct the information and submit a new claim or update returned claim. If the actual date of death was reported in error to the Social Security office, [...]

U5600

Avoiding/Correcting This Error Providers should develop and implement a process to ensure that duplicate claims are not being submitted. If the claim is truly a duplicate, no action is necessary If this is not a duplicate and the provider [...]

37364

Avoiding/Correcting This Error There was an issue with NOAs incorrectly editing for U537F. Once the system was fixed, NOAs could be resubmitted and subsequently processed. NOAs submitted late due to this issue may have affected more than one [...]

38055

Avoiding/Correcting This Error Verify the claim history using the FFS/DDE Provider Online system, your remittance advice and/or the CWF to determine the episode claim that is causing the overlap If there are services that should have been [...]

38200

Avoiding/Correcting This Error This reason code may be applied when an NOA and period of care claim are submitted at the same time or when an NOA and one is already in the system. If the NOA and claim were submitted at the same time, and no [...]

39934

Avoiding/Correcting This Error You can find line level information by accessing MAP171D in the FISS/DDE Provider Online System: Hit <F2>/<PF2> once or <F11>/<PF11> twice from Claim Page 02 of the claim to access [...]

Prepare and Submit a Medicare Secondary Payer Claim

Table of Contents Background Step 1: Determine If You Must Submit an MSP Claim Step 2: Prepare an MSP Claim MSP Billing Code Table Step 3: Check for a Matching MSP Record for the Beneficiary in the Common Working File Step [...]

Contractor Advisory Committee Meeting

Contractor Advisory Committee Meeting As part of the 21st Century Cures Act, contractors are mandated to base an LCD on robust evidence. Part of the process is to convene SMEs as necessary to review the literature and provide input that [...]

Multi-Jurisdictional Peripheral Nerve Blocks Contractor Advisory Committee Meeting on 2/3/2025

Multi-Jurisdictional Peripheral Nerve Blocks Contractor Advisory Committee Meeting on 2/3/2025 The Multi-Jurisdictional Peripheral Nerve Blocks Contractor Advisory Committee Meeting is scheduled for 2/3/2025 from 2:00–4:00 p.m. ET, via [...]

MLN Connects® Newsletter: January 16, 2025

MLN Connects® Newsletter: January 16, 2025 News Resources & Flexibilities to Assist with the Public Health Emergency in California CMS Moves Closer to Accountable Care Goals with 2025 Accountable Care Organization Initiatives [...]

FQHC and RHC Claims RTP for W7072

Between 10/1/2024 and 12/31/2024, RHC (TOB 071X) and FQHC (TOB 077X) claims that contained HCPCS code 93010 were RTP in error with reason code W7072.

Letters Regarding Deactivation of Enrollment Due to Infrequent Billing - Correction of Fax Number

Letters Regarding Deactivation of Enrollment Due to Infrequent Billing - Correction of Fax Number If you received a letter from National Government Services dated 1/10/2025 regarding a deactivation of your enrollment due to infrequent billing, [...]

2024 Calendar Year 1099 Form Information

2024 Calendar Year 1099 Form Information National Government Services will mail all 1099 Forms for calendar year 2024 no later than 1/31/2025. Medicare providers and beneficiaries, who are serviced by NGS regardless of their location, will [...]

Improving Customer Experience

Improving Customer Experience We are committed to improving your experience. Please watch this two-minute video that explains how each day we review comments from providers who submit surveys to let us know what is working well and how we can [...]

Connecticut ASC Fee Schedule Listing

Connecticut ASC Fee Schedule Listing  CMS is using CBSA planning areas/numbers instead of counties for fee schedule listings for ASCs in the state of Connecticut.  CBSAs refer collectively to metropolitan statistical areas and [...]

Fee Schedule Assistance

Fee Schedule Assistance Connecticut Illinois Locality/Area and County Information Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Locality/Area and County Information New York Locality/Area and County Information Locate and [...]

Jurisdiction K Part B Top Claim Errors Are Updated

Jurisdiction K Part B Top Claim Errors Are Updated Did you know we publish the top claim errors on our website? This resources provides detailed information including: the error reason code; a description of the error; the error type; [...]

What are the administration codes for the pneumococcal vaccine?