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

CLAIMS: On a screening Pap smear test claim, which pointer does my diagnosis code need to be in?

MLN Connects® Newsletter: July 15, 2025

MLN Connects® Newsletter: July 15, 2025 CMS Proposes Physician Payment Rule to Significantly Cut Spending Waste, Enhance Quality Measures, and Improve Chronic Disease Management for People with Medicare Posted 7/15/2025

[RESOLVED] NGSConnex and IVR Experiencing Outages

[RESOLVED] NGSConnex and IVR Experiencing Outages We were experiencing outages with our web portal, NGSConnex and the IVR System. Part B providers were unable to check claim status, appeal status or submit appeal and reopening requests via [...]

Modifier 22 Supporting Documentation for Part B claims

Modifier 22 Supporting Documentation for Part B claims The Centers for Medicare & Medicaid Services, Internet-Only-Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 40.2.10 Unusual Circumstances states: [...]

APPEALS: What is the appeal process?

APPEALS: How would one submit a paper appeal?

CAR-T: Will the Part A claim for CAR-T deny if it is submitted with the KX modifier?

CAR-T: What is the effective date for the requirement of the KX modifier for administration of CAR-T?

CAR-T: Is the KX modifier required for Part A and Part B claims?

CAR-T: Is Risk Evaluation and Mitigation Strategy (REMS) verified by the facility’s site name or address?

Home Health Top Claim Errors

Do you see the same rejections and return to providers over and over? Do you know how to correct the most common errors and more importantly how to avoid them in the future? In this session we’ll review the most common reason codes assigned to [...]

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

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

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 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 do I respond to an ADR Not In List?

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

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

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

MEDICAL REVIEW: What constitutes a valid signature?

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

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

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

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

MODIFIERS: When is modifier 50 used?

MODIFIERS: When should the QW modifier be appended?

MODIFIERS: When do I need to append the 99 modifier?

MODIFIERS: When is it appropriate to append the AQ modifier?

MODIFIERS: When should modifier 51 be added to a claim?

Preventive Services: Screening for STIs/HIBC to Prevent STIs, Hepatitis B, Hepatitis C Virus and HIV including HIV PrEP

This webinar is the latest in a series of Medicare preventive services webinars. During this session, we’ll review the Medicare coverage, coding and billing guidelines for screening for sexually transmitted infections (STIs)/high intensity [...]

What are the administration codes for the pneumococcal vaccine?

Does Medicare pay for counseling and education of the pneumococcal vaccine?

What is the frequency requirement for the pneumococcal vaccine?

If I administer two different vaccinations during the same visit, e.g., influenza and pneumococcal, can I bill for two separate administrations?

Is the pneumococcal vaccine subject to coinsurance and deductible?

Is an order required to administer the pneumococcal vaccine?

What are the allowance limits for the cost of the pneumococcal vaccine?

Can a mass immunizer combine pneumococcal with other vaccines on one roster bill?

Where are the appeal forms?

What is the timely filing for an appeal?

What is the receipt date of the claim?

What is the QIC timely filing limit?

What is the denial date?

What is the refund address?

What is timely filing for a claim?

What is my pay-to address?

Where is the written Part B Reopening Form located?

What is timely filing to adjust a claim?

What is my Payer ID?

Does Medicare cover a sign language interpreter?

What is the mailing address for submitting a claim?

What is the address to send the QIC appeal?

What is the ICN?

LCD NCD: What are Medical Policy Articles?

LCD NCD: Does NGS offer any other LCD resources?