CLAIMS: I file all my Medicare claims electronically except for Medicare Secondary Payer (MSP) claims because I thought I had to attach the primary Explanation of Benefits (EOB). Is this the correct process?

CLAIMS: How do I submit documentation for an additional development request (ADR)?

CLAIMS: I am receiving inconsistent payments on claims billed for the same drug. How can I prevent this?

CLAIMS: How do I prevent monthly End Stage Renal Disease claims from denying?

CLAIMS: How do I know if a HCPCS/CPT code is subject to MUE (medically unlikely edit)?

CLAIMS: During the patient check in process, may we have the patient check a box on a form at each visit stating they agree to allow us to bill Medicare and have that serve as the patient’s acceptance for our filing a claim?

When billing for waste on a single use vial would you round units up or down for a half unit?

When billing an unclassified drug code such as J3490, are the units of service on the claim always equal to one?

What is the proper way to submit professional physician claim with multiple NDC numbers for the same drug code?

J3357, Ustekinumab (Stelara) is listed on the Self-Administered Drug Exclusion List: Medical Policy Article A53021, and it says “acceptable”. Does this mean it is excluded or not?

What is the correct way to bill an unlisted drug or biological?

Is the shingles vaccine covered by Medicare?

Is the GY modifier required on the drug code and the administration code for noncovered self-administered drugs?

Have the payable diagnoses for IVIG and Rituximab changed? I don’t see all of the previously payable diagnoses in the applicable drug local coverage determinations (LCDs) and articles.

How do I bill a bilateral joint injection and HCPCS J1040 for two units?

Do all established drug HCPCS codes require the dosage amount in its description on the claim?

Does the waste with the JW modifier appended always go on the second line regardless of the billed amount? For example, the billed amount for the waste is higher than the administered amount.

Are unclassified drug codes included in average sales price (ASP) files?

Can chemotherapy be split into two doses on two different dates of service if the patient was unable to complete a full dose in one day? For example, the patient's port was not functioning properly.

Does Medicare Part B make payment for the unused portion of a multi-dose vial of a drug/biological?

Can Medicare Part B providers who bill on the professional CMS-1500 claim form, and electronic equivalent, bill unclassified drug code C9399?

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

Additional Events Links

Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders

MEDICAL REVIEW: Why did I receive a Comparative Billing Report?

MEDICAL REVIEW: Where can I get answers to billing questions?

MEDICAL REVIEW: Where can I find more details about the reasons my claims were denied?

MEDICAL REVIEW: What constitutes a valid signature?

MEDICAL REVIEW: What mailing address does NGS use to send Medical Review additional documentation requests (ADRs) to providers?

MEDICAL REVIEW: We are a large group and could potentially have many providers on TPE review. We have difficulty managing the process for each provider. Does NGS have any guidance for large groups?

MEDICAL REVIEW: The Medical Review Department did a post payment review of my Medicare claim and it was denied. How do I pay the money back to NGS Medicare?

MEDICAL REVIEW: My claim was denied “56900 Documentation not received”; however, I did send in documentation. What now?

MEDICAL REVIEW: My claim was reopened or adjusted by Medical Review. Does this impact the appeal window?

MEDICAL REVIEW: How do I sign up for the CMS and NGS Listserv messages?

MEDICAL REVIEW: I am under TPE review and my claims were denied, who can I speak to about this?

MEDICAL REVIEW: I’m appealing my claim but received a letter to recoup funds from the TPE denial. What do I do about these letters?

MEDICAL REVIEW: How do I change my address and which address exactly am I changing to ensure receipt of the MR letters and ADRs?

MEDICAL REVIEW: How do I respond to an ADR Not In List?

MEDICAL REVIEW: How do I request an appeal on a claim reviewed by the Medical Review Department?

MEDICAL REVIEW: How do I appeal a claim that MR reviewed but went to a T status or R status because of a CWF issue after MR processed?

MEDICAL REVIEW: How can I use NGSConnex to respond to Medical Review additional documentation requests?

Resources

Resources You Can Help Your Patients Quit Tobacco Use Smoking Cessation Tools and Resources Smokefree.gov Centers for Disease Control and Prevention: Tips from Former Smokers campaign Centers for Disease Control and Prevention: Office on [...]

COVID-19 Vaccine and Monoclonal Antibody

COVID-19 Vaccine and Monoclonal Antibody With the end of the PHE, as of 5/11/2023, this information no longer applies. We will keep the information available for PHE-related services that occurred prior to the expiration date that have not yet [...]

Prepare and Submit an MSP Claim

Table of Contents Step 1: Determine if an MSP Claim Must be Submitted to Medicare Step 2: Check Medicare’s Eligibility Files via NGSConnex to Determine if There's Other Insurance Primary to Medicare Step 3: Prepare the MSP (Partial-Payment [...]

837D Edit Spreadsheet

Expedited Requests

Expedited Requests The requester may submit for an expedited review of the PAR if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function. If the medical documentation does [...]

NGS Review of Prior Authorization Request

NGS Review of Prior Authorization Request Table of Contents NGS Review of Prior Authorization Request Number of Trips Extended Affirmation Periods for Beneficiaries with Chronic Conditions Decision Letters Resubmitting a Prior [...]

About Hospital OPD PA Model

About Hospital OPD PA Model Table of Contents About Hospital OPD PA Model General Information Related Content [Return to Top] About the Hospital OPD PA Model CMS implemented a PA program for certain hospital OPD services for DOS on [...]

Documentation Information

Documentation Information It is recommended that PARs are submitted at least seven calendar days prior to the expected date of service to allow National Government Services the full standard timeframe to receive and review requests. For [...]

Safeguard Your Finances: Know Your Provider Enrollment Revalidation

Safeguard Your Finances: Know Your Provider Enrollment Revalidation  Attention: Provider Enrollment and Credentialing Teams Ensure you revalidate before your deadline to prevent a "Stay of Enrollment" or claim rejections, which could [...]

Office/Outpatient Evaluation and Management Visit Complexity Add-on Code G2211

Office/Outpatient Evaluation and Management Visit Complexity Add-on Code G2211 Effective 1/1/2024 Definition of G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing [...]

Provider Enrollment: Top Reasons Behind Delays in Processing the Application

Provider Enrollment: Top Reasons Behind Delays in Processing the Application Medicare enrollment plays a vital role in ensuring compliance with CMS requirements. To help streamline the process and achieve the best results, it's important to [...]

Fiscal Intermediary Standard System Direct Data Entry Screen Changes – April 2025

Fiscal Intermediary Standard System Direct Data Entry Screen Changes – April 2025 The April 2025 quarterly system release will update FISS DDE as described below: Inquiries Submenu (01) Option 1C (CMHC Payment Totals)/MAP1D62 - Monetary [...]

Tobacco Cessation and Cognitive Behavioral Therapy

Tobacco Cessation and Cognitive Behavioral Therapy CBT is a type of psychotherapy that’s problem oriented. It may help your patients learn how to change unhelpful or unhealthy ways of thinking, feeling and behaving especially when related to [...]

Provider Enrollment: Top Reasons Behind Delays in Processing the Application

Provider Enrollment: Top Reasons Behind Delays in Processing the Application Medicare enrollment plays a vital role in ensuring compliance with CMS requirements. To help streamline the process and achieve the best results, it's important to [...]

MCReF Hospice Cap Functionality

MCReF Hospice Cap Functionality Attention Hospice providers: The new MCReF Hospice Cap functionality will be covered in the upcoming MCReF Webinar scheduled for 3/19/2025, from 1:00 – 3:00PM ET.  The Hospice Cap provider community is [...]

Hospital Inpatient or Observation Evaluation and Management Add-On Code G0545 for Infectious Diseases

Hospital Inpatient or Observation Evaluation and Management Add-On Code G0545 for Infectious Diseases Effective 1/1/2025 Definition of G0545 Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or [...]

Log In

Log In Table of Contents Log In Log into NGSConnex Log In Issues [Return to Top] Log In In order to login to NGSConnex, go to our website landing page. Read the standard disclaimer and click Accept to continue. [Return to [...]

Account Suspensions

Account Suspensions Table of Contents Account Suspensions Unsuspend Your Account Invalid Login Attempts [Return to Top] Account Suspensions If an NGSConnex account has not been used within the last 30 days, the account will be [...]

Caregiver Training Services

Caregiver Training Services Effective 1/1/2024, payment will be made when practitioners train caregivers to support patients with certain diseases or illnesses (e.g., dementia) in carrying out a treatment plan. A caregiver is defined as a [...]