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Posting Date: 11/16/2021
Technical Guides and Information
Technical Guides and Information 5010 Process Flow Chart X12 Website: Technical Reports/Implementation Guides, Newsletters and X12 Transaction Sets Reviewed 6/23/2025
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Posting Date: 07/23/2024
Calculating the Batch Receipt Date
Calculating the Batch Receipt Date When a file is received in the EDI Gateway, the date and time received are applied as the receipt date of the claim(s). A business day is considered 12:00 a.m. to 4:59:59 p.m. ET Monday through Friday. [...]
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Posting Date: 06/23/2025
Benefits of EDI
There are a number of advantages to enrolling and submitting claims online. Claims and other transactions submitted electronically process considerably faster than paper submission. For example, HIPAA-compliant electronic claims are held in the [...]
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Posting Date: 01/29/2020
Benefits of Electronic Attachments
Benefits of Electronic Attachments The X12 275 Attachment transaction supports sending additional documentation electronically. Clinical documentation includes but not limited to; operative notes, consult notes, procedure notes, care plan, and [...]
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Posting Date: 01/29/2020
EDI and How it Works
EDI and How it Works EDI is an electronic communication method that enables fast, accurate and reliable exchange of data between the computer systems of organizations that do business together by using the same standardized message formatting, [...]
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Posting Date: 03/16/2021
EDI Solutions JK
Helpful Resources EDI Front End Rejection Code Lookup Tool Reset My EDI Password Contact the EDI Help Desk 888-379-9132 Available by phone or email Monday–Friday* 8:00 a.m.–5:00 p.m. ET 7:00 a.m.–4:00 p.m. CT * Closed for training on the [...]
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Posting Date: 10/01/2024
New Version of PC-ACE: January 2025
New Version of PC-ACE: January 2025 PC-ACE Version 6.5 contains several CMS mandates and product enhancements including but not limited to the items listed below. Change Request (CR) 13794 - Combined Common Edits/Enhancements Modules [...]
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Posting Date: 03/16/2021
EDI Solutions J6
Helpful Resources EDI Front End Rejection Code Lookup Tool Reset My EDI Password Contact the EDI Help Desk 877-273-4334 Available by phone or email Monday–Friday* 8:00 a.m.–5:00 p.m. ET 7:00 a.m.–4:00 p.m. CT * Closed for training on the [...]
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Posting Date: 01/29/2020
Key Features
Key Features PC Print offers several different report displays and the ability to print the reports as needed. The Single Claim Report includes the activity at the claim and detail line items for a single claim. The All Claims Report [...]
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Posting Date: 01/18/2022
Quarterly Top Ten Institutional EDI Edits
Quarterly Top Ten Institutional EDI Edits National Government Services EDI has identified the following top ten CEM edits that were received during Q1 2025 on the 277CA (Claims Acknowledgement) report for 837I 5010A1 formatted [...]
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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: 07/17/2024
Billing Hospice Transfers
Billing Hospice Transfers Once a beneficiary elects to receive care under the Medicare hospice benefit, he or she waives rights to Medicare payments for hospice care provided by any other hospice other than the one they have chosen/designated. [...]
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Hospice Notice of Election Termination/Revocation (Type of Bill 8xB)
Hospice Notice of Election Termination/Revocation (Type of Bill 8xB) Table of Contents Hospice Notice of Election Termination/Revocation Examples of NOTR Time Frames Reminders/Notes on the NOTR Correcting a Discharge Date on an [...]
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Posting Date: 12/20/2016
Hospice Room and Board Denials
Hospice Room and Board Denials Medicare does not pay the room and board fees for hospice beneficiaries that reside in a SNF or a nursing facility (NF), as these charges are statutorily excluded from Medicare coverage. However, these charges [...]
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Posting Date: 05/18/2021
Professional Services During a Patient Hospice Election
Professional Services During a Patient Hospice Election Table of Contents Article Overview Hospice Election Medicare Payment During Hospice Election Determining the Correct Entity to Bill Separately Payable Part B Services [...]
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Posting Date: 11/25/2024
Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024
Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024 After carefully considering recent feedback about the increasing operational challenges of the Hospice Benefit Component and limited and decreasing participation [...]
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Posting Date: 12/11/2024
Provisional Period of Enhanced Oversight for New Hospices
Provisional Period of Enhanced Oversight for New Hospices In recent years, CMS has reported a significant increase in fraudulent hospice billing practices, which cost the Medicare Program millions of dollars annually. The CMS has initiated a [...]
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Posting Date: 03/28/2016
Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted Retroactive Medicare Entitlement
Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted Retroactive Medicare Entitlement Table of Contents Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted [...]
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Posting Date: 12/21/2017
Hospice Billing Codes Chart
Hospice Billing Codes Chart Table of Contents Hospice Billing Codes Chart Condition Codes (CC) (UB-04 FL 18-28) Occurrence Codes (OC) and Dates (UB-04 FLs 31-34) Occurrence Span Code and Date (UB-04 FLs 35-36) Value Codes (VCs) and CBSA [...]
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Posting Date: 05/14/2018
Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77
Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77 Table of Contents Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77 Example of the Proper Use of OC 27 Example of the Proper Use of OC 27 with OSC 77 [...]
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Posting Date: 04/19/2018
Filing an Electronic Notice of Change of Ownership (TOB 8XE)
Filing an Electronic Notice of Change of Ownership (TOB 8XE) The Notice of Change of Ownership (TOB 8XE) is submitted when the hospice has a change of ownership that results in a change of the PTAN. Please refer to the Hospice Change of [...]
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Posting Date: 04/19/2018
Hospice Change of Ownership
Hospice Change of Ownership Table of Contents Hospice Change of Ownership What is Not a CHOW The Provider Enrollment Process Purchase Agreement Merger/Acquisition [Return to Top] Hospice Change of Ownership CHOW is defined [...]
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Posting Date: 05/02/2018
Filing an Electronic Notice of Cancelation (Type of Bill 8XD)
Filing an Electronic Notice of Cancelation (Type of Bill 8XD) Table of Contents Filing an Electronic Notice of Cancelation (Type of Bill 8XD) Steps to Cancel a NOE Steps to Cancel a Benefit Period Submitting the 8XD Related Content [...]
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Posting Date: 09/30/2021
Filing an Electronic Notice of Transfer (Type of Bill 8XC)
Filing an Electronic Notice of Transfer (Type of Bill 8XC) Table of Contents Filing an Electronic Notice of Transfer (Type of Bill 8XC) Correcting the Transfer Date on a Previous Submitted Notice of Transfer Related Content [Return to [...]
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Posting Date: 12/19/2016
Hospice Site of Service Codes
Hospice Site of Service Codes Table of Contents Hospice Site of Service Codes HCPCS Codes Site of Service Location Notes Edits Related Content [Return to Top] Hospice Site of Service Codes Hospice agencies must report an HCPCS [...]
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Posting Date: 07/10/2017
The Medicare Hospice Benefit: Effects on Other Provider Types
The Medicare Hospice Benefit: Effects on Other Provider Types Table of Contents The Medicare Hospice Benefit: Effects on Other Provider Types What is Hospice Care Providing Services Related to the Terminal Condition Providing Services [...]
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Posting Date: 03/22/2017
Reporting Hospice Discharges, Revocations and Transfers
Reporting Hospice Discharges, Revocations and Transfers Medicare regulations at 42 CFR 418.26 outline three reasons for discharge from hospice care: The beneficiary moves out of the hospice’s service area or transfers to another [...]
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Posting Date: 06/20/2025
Benefits of EDI
There are a number of advantages to enrolling and submitting claims online. Claims and other transactions submitted electronically process considerably faster than paper submission. For example, HIPAA-compliant electronic claims are held in the [...]
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Posting Date: 06/20/2025
Reset My FISS / DDE Password
CMS has directed it’s datacenters to enforce password requirements set forth in the United States Defense Information Systems Agency’s (DISA) Security Technical Implementation Guide (STIG) with regard to RACF password quality rules. The HPE VDC [...]
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Posting Date: 06/20/2025
I Am Not Yet Enrolled in Medicare
You can only begin set up with EDI if you are a participating provider in the Medicare program. If you have not submitted an application to enroll in Medicare, please visit our Enrollment section of the site for guidelines. If you have a [...]
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Posting Date: 06/20/2025
Trading Partner ID Recertification
All active trading partners are required to recertify their access annually. CMS requires any changes in demographic, contact information or access for a trading partner ID (TP ID) are communicated to the A/B MAC within 30 days of the change. [...]
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Posting Date: 07/19/2023
National Government Services Contractor Codes
National Government Services Contractor Codes The Contractor Code is a five-digit numeric code that indicates your MAC, also known as the Carrier Code, or Payer ID. Part B Professional: Connecticut 13102 Illinois 06102 Maine 14112 [...]
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Posting Date: 05/01/2018
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 [...]
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Posting Date: 11/09/2015
Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims
Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims Once a hospice chooses to admit a Medicare beneficiary, it may not automatically or routinely discharge the beneficiary at its discretion, even if the care promises [...]
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Posting Date: 07/19/2019
Filing an Electronic Notice of Election (Type of Bill 8XA)
Filing an Electronic Notice of Election (Type of Bill 8XA) The NOE, TOB 8XA, is submitted when the hospice receives a signed election statement from the beneficiary acknowledging that he/she wishes to enroll in the Medicare hospice benefit. [...]
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Posting Date: 06/09/2022
Value-Based Insurance Design Model Hospice Benefit Component Overview
Value-Based Insurance Design Model Hospice Benefit Component Overview Beginning on 1/1/2021, CMS is testing the inclusion of the Part A Hospice Benefit within the MA benefits package through the Hospice Benefit Component of the VBID Model. [...]
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Posting Date: 09/29/2017
Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines
Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines Medicare covers influenza virus, pneumococcal and hepatitis B vaccines in accordance with coverage requirements, when furnished by a hospice to those [...]
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Posting Date: 05/14/2018
Canceling a Hospice Notice of Election
Canceling a Hospice Notice of Election When a patient elects hospice, the hospice submits a NOE to the MAC to notify the MAC and all other providers that the patient is now utilizing the Medicare hospice benefit for all services related to the [...]
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Posting Date: 05/11/2018
Hospice Visit Reporting
Hospice Visit Reporting Table of Contents Background Discipline Visits Reporting Visits in the Routine Home Care, Continuous Home Care and Inpatient Respite Care Levels of Care Discipline Revenue and HCPCS Coding Required Detail for [...]
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Posting Date: 03/18/2022
Hospice Quality Reporting Program
Hospice Quality Reporting Program Along with the other MACs, National Government Services has received several requests from new hospice providers, as well as national and state hospice associations, regarding training and assistance for [...]
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Posting Date: 03/30/2020
How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period
How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period Background CMS requires that a hospice physician or hospice nurse practitioner must have a FTF encounter with each hospice patient prior to the beginning of the [...]
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Posting Date: 06/20/2025
EDI Enrollment Process User Guide
This guide provides information on the different options available within the National Government Services EDI Enrollment Process User Guide. Please share your thoughts about your experience with our EDI Enrollment process. Reviewed [...]
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Posting Date: 06/20/2025
EDI Enrollment
Welcome This page is for providers who wish to submit Part A/B claims to Medicare. Once you have completed the initial provider enrollment and received your Welcome letter with Medicare, you can begin the EDI Enrollment process. Table of [...]
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Posting Date: 06/20/2025
HETS EDI Enrollment Form
HIPAA Eligibility Transaction System (HETS) allows users to exchange HIPAA compliant ANSI ASC X12 270/271 transactions for the purpose of checking Medicare eligibility. The HETS EDI Enrollment Form allows providers to attest their [...]
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Posting Date: 09/21/2020
Interactive Voice Response System
Interactive Voice Response System State IVR Number Hours Available* Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont 877-567-7205 Monday–Friday: 6:00 a.m.–7:00 p.m. ET [...]
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Posting Date: 04/22/2021
Provider Contact Center
Provider Contact Center Table of Contents Want to talk to us? Make the Most of Your Call Customer Care Representative Assistance Interactive Voice Response System NGSConnex Online Inquiry System Freedom of Information Act (FOIA) [...]
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Posting Date: 04/01/2020
EDI Help Desk Information
EDI Help Desk Information Toll-Free Number Jurisdiction 6: 877-273-4334 Jurisdiction K: 888-379-9132 Hours of Operation Monday–Friday: 8:00 a.m.–5:00 p.m. ET * Closed for training on the 2nd and 4th Friday of the month from 12:00–4:00 [...]
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Posting Date: 06/09/2021
About Hospital OPD PA Model
About Hospital OPD PA Model Table of Contents General Information Related Content [Return to Top] General Information Question Description WHO It is the responsibility of the hospital OPD to submit all [...]
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Posting Date: 06/09/2021
Expedited Requests
Expedited Requests The requester may submit 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 not [...]
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Posting Date: 06/23/2025
Part A Ambulance Transport: Understanding the Basics
The purpose of this presentation is to give Medicare Part A Ambulance providers a better understanding of who is responsible to report services to Medicare.
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Posting Date: 06/09/2021
Ways to Submit Requests
Ways to Submit Requests NGSConnex Part A: NGSConnex User Guide Part B: NGSConnex User Guide esMD Content type 8.5 Fax JK: 317-841-4530 J6: 317-841-4528 Mail National Government Services, Inc. [...]
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Posting Date: 06/09/2021
OPD Facility/Physician Communication
OPD Facility/Physician Communication The implementation of the Outpatient Department (OPD) Prior Authorization (PA) program has specific implications for Part B physicians performing services within hospital OPDs. Each prior authorization [...]
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Posting Date: 05/03/2024
About Prior Authorization
About Prior Authorization CMS has implemented Prior Authorization (PA) programs nationwide to ensure that Medicare beneficiaries continue to receive reasonable and necessary care while protecting the Medicare Trust Fund from improper payments. [...]
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Posting Date: 06/23/2025
Description of Application Fee
The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2025 is $730. Related Content Federal Register Notice ‒ information about how the fee was calculated [...]
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Posting Date: 01/05/2021
Description of Application Fee
Description of Application Fee The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2025 is $730. Related Content Federal Register Notice ‒ information [...]
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Posting Date: 01/05/2021
Description of Application Fee
Description of Application Fee The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2025 is $730. Related Content Federal Register Notice ‒ information [...]
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Posting Date: 01/05/2021
Description of Application Fee
Description of Application Fee The application fee is imposed on institutional providers and suppliers to cover enrollment costs. The application fee for calendar year 2025 is $730. Related Content Federal Register Notice ‒ information [...]
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Posting Date: 04/14/2022
How to Submit a Hardship Request
How to Submit a Hardship Request To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be [...]
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Posting Date: 04/14/2022
How to Submit a Hardship Request
How to Submit a Hardship Request To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be [...]
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