October 2019 EDI Front-End Quarterly Release: New and Modified Edits

October 2019 EDI Front-End Quarterly Release: New and Modified Edits Please note that there are no new, modified, or deleted edits changes for Part B within the October 2019 Release. The Part A edit changes are listed below:  Part A Edit [...]

Reminder: Annual Mandatory Deadline for Submitting Low Volume ESRD Facility Adjustment Requests for CY 2020 Are Due by 11/1/2019

Reminder: Annual Mandatory Deadline for Submitting Low Volume ESRD Facility Adjustment Requests for CY 2020 Are Due by 11/1/2019 Attention End-Stage Renal Dialysis Facilities Per 42 CFR Section 413.232, CMS notified ESRD providers that [...]

MLN Connects® for Thursday, September 5, 2019

MLN Connects® for Thursday, September 5, 2019 September is Pain Awareness Month - Learn Pain Management Options MLN Connects® for Thursday, September 5, 2019 View this edition as a PDF News New Medicare Card: Do You Refer Patients? [...]

MLN Connects® for Thursday, August 29, 2019

MLN Connects® for Thursday, August 29, 2019 New Medicare Card: Open Door Forum — September 11 MLN Connects® for Thursday, August 29, 2019 View this edition as a PDF News Promoting Interoperability: 2019 PDMP Bonus Measure [...]

NGSConnex Security Requirements

NGSConnex Security Requirements We frequently receive suggestions to improve NGSConnex by implementing less restrictive or eliminating some of our security requirements. Although we understand these security requirements often feel excessive, [...]

MLN Connects® for Thursday, August 22, 2019

MLN Connects® for Thursday, August 22, 2019 New Medicare Card: Read the Updated MLN Matters Article MLN Connects® for Thursday, August 22, 2019 View this edition as a PDF News Overall Hospital Quality Star Ratings: Upcoming [...]

MLN Connects® for Thursday, August 15, 2019

MLN Connects® for Thursday, August 15, 2019 New Medicare Card: Transition Period Ends in Less Than 5 Months MLN Connects® for Thursday, August 15, 2019 View this edition as a PDF News New Medicare Card: Transition Period Ends in [...]

MLN Connects® for Thursday, August 8, 2019

MLN Connects® for Thursday, August 8, 2019 New Medicare Card: Will Your Claims Reject? MLN Connects® for Thursday, August 8, 2019 View this edition as a PDF News New Medicare Card: Will Your Claims Reject? Securing Access to [...]

MLN Connects® Special Edition - Wednesday, August 7, 2019

MLN Connects® Special Edition - Wednesday, August 7, 2019 Don't Miss Out: Register for Payment Rule Listening Sessions Today Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session — August 12 OPPS and ASC [...]

Reminder: Medicare Part B Providers Receiving Hardcopy Standard Paper Remittances – Moving to Biweekly Mailing Schedule

Reminder: Medicare Part B Providers Receiving Hardcopy Standard Paper Remittances – Moving to Biweekly Mailing Schedule Beginning 8/9/2019, we will change from a weekly to biweekly mailing schedule for Part B hard copy SPR. The only exception [...]

MLN Connects® Special Edition - Friday, August 2, 2019

MLN Connects® Special Edition - Friday, August 2, 2019 IPPS/LTCH: FY 2020 PPS Final Rule IRF: FY 2020 Payment and Policy Changes Hospice: FY 2020 Hospice Payment Rate Final Rule IPPS/LTCH: FY 2020 PPS Final Rule On August 2, CMS [...]

August is National Immunization Awareness Month

August is National Immunization Awareness Month This annual health observance is a great opportunity to educate seniors and other Medicare beneficiaries about the importance of disease control and prevention through immunization. [...]

MLN Connects® for Thursday, August 1, 2019

MLN Connects® for Thursday, August 1, 2019 Protect Your Patients’ Identities: Use the MBI Now MLN Connects® for Thursday, August 1, 2019 View this edition as a PDF News SNF: FY 2020 Payment and Policy Changes IPF: FY 2020 [...]

MLN Connects® Special Edition - Monday, July 29, 2019

MLN Connects® Special Edition - Monday, July 29, 2019 Medicare and ASC Payment System CY 2020 Proposed Rule ESRD and DMEPOS CY 2020 Proposed Rule PFS: Proposed Policy, Payment, and Quality Provisions Changes for CY 2020 On July 29, [...]

MLN Connects® for Thursday, July 25, 2019

MLN Connects® for Thursday, July 25, 2019 Questions about Using the MBI? MLN Connects® for Thursday, July 25, 2019 View this edition as a PDF News New Medicare Card: Questions about Using the MBI? 2020 QRDA III Implementation Guide, [...]

Targeted Probe and Educate Letters – An Informational Overview

Targeted Probe and Educate Letters – An Informational Overview As part of our contractual obligation with the CMS, NGS, your Jurisdiction 6 or K MAC performs TPE to analyze provider compliance with CMS regulatory requirements. The TPE review [...]

Health and Human Services Office of Inspector General Telehealth and Potential Fraud

Health and Human Services Office of Inspector General Telehealth and Potential Fraud The DHHS, of whom the CMS reports to, published a brief last week from the OIG regarding telehealth and the PHE expansion of services. The article addresses [...]

Understanding your Remittance Advice for Merit-Based Incentive Payment System Adjustments

Understanding your Remittance Advice for Merit-Based Incentive Payment System Adjustments National Government Services has seen an increase in invalid overpayment requests related to the MIPS program. MIPS is part of the QPP that determines [...]

MLN Connects® Special Edition for Thursday, February 3, 2022

MLN Connects® Special Edition for Thursday, February 3, 2022 Biden-Harris Administration Will Cover Free Over-the-Counter COVID-19 Tests Through Medicare CMS Developing Initiative to Enable Access to Eight Free Over-the-Counter COVID-19 Tests [...]

Provider Enrollment Authorization and Accreditation

​​​​​​​Provider Enrollment Authorization and Accreditation Provider Enrollment added articles State License and Registrations for Certified Providers and Suppliers and Certified Provider and State Survey Agency for reminders, clarification and [...]

Top Claim Errors

Top Claim Errors Did you know we publish the top claim errors on our website? This information provides you with: the error reason code; a description of the error; the error type; details that include steps you can take to [...]

Jurisdiction 6 State Licensing and Certification Websites

Jurisdiction K State Licensing and Certification Websites

Jurisdiction 6 State Licensing and Certification Websites

Jurisdiction K State Licensing and Certification Websites

Provider Enrollment: Obtaining and Verifying State License

Provider Enrollment: Obtaining and Verifying State License Providers must contact their State agency when initially enrolling or making a change to a current Medicare enrollment for certification materials for their provider/supplier type. For [...]

Certified Provider and State Survey Agency

Certified Provider and State Survey Agency

MLN Connects® Newsletter for Thursday, August 4, 2022

MLN Connects® Newsletter for Thursday, August 4, 2022 ICD-10-CM Code Files: Fiscal Year 2023 News Hospices: Volunteer to Test Hospice Outcomes & Patient Evaluation Instrument Immunization: Protect Your Patients Claims, Pricers, [...]

Modifier 52 Claim Submission Billing Reminder

Modifier 52 Claim Submission Billing Reminder National Government Services found that on many occasions, providers are billing for reduced services with modifier 52 appended to the CPT code; however, they are billing the regular charged amount [...]

Comprehensive Error Rate Testing Redetermination Deadline 9/27/2022

Comprehensive Error Rate Testing Redetermination Deadline 9/27/2022 The CERT RY 2022 is quickly coming to an end. The deadline for redetermination completion is 9/27/2022 to be considered for the CERT RY. National Government Services requests [...]

Comprehensive Error Rate Testing Documentation Deadline 8/22/2022

Comprehensive Error Rate Testing Documentation Deadline 8/22/2022 The CERT RY 2022 is quickly coming to an end. In order to give sufficient time for the CERT RC to complete the review of your claims, all documentation and additional [...]

October 2022 Release "Dark Days" for the Common Working File Hosts

October 2022 Release "Dark Days" for the Common Working File Hosts For the upcoming October 2022 Release: For Production, CWF will be observing the Gray Day on Thursday, September 29th and Dark Days starting Friday, September 30th through [...]

MLN Connects® Newsletter for Thursday, August 11, 2022

MLN Connects® Newsletter for Thursday, August 11, 2022 Monkeypox & Smallpox Vaccines: New Product Codes News Monkeypox & Smallpox Vaccines: New Product Codes Payment Allowance Update for COVID-19 Monoclonal Antibody Therapy [...]

CMS Identifies National System Issue

CMS Identifies National System Issue CMS identified a national system issue, which may have inadvertently adjusted previously processed Part B claims with dates of service (DOS) on or after January 1, 2021. These adjustments processed on July [...]

National Government Services Medicare Spring 2022 Virtual Conference

National Government Services Medicare Spring 2022 Virtual Conference Medicare For You Wednesday, 5/11/2022 – Thursday, 5/12/2022 The NGS Provider Outreach and Education Team is holding our latest bi-annual virtual conference on Wednesday, [...]

Log Out

Log Out You will be logged out of NGSConnex automatically after 30-minutes of inactivity. This is a CMS - security requirement to protect provider and beneficiary information. When you are ready to exit the system, click Log Out icon located [...]

Are You Registered? The Spring 2022 Virtual Conference Medicare for You Begins Tomorrow!

Are You Registered? The Spring 2022 Virtual Conference Medicare for You Begins Tomorrow! Medicare for You offers valuable information that is fundamental for you, as a provider, to submit claims with the needed information so you realize the [...]

Submit an Adjustment to Correct Claims Partially Denied by Automated LCD-NCD Denials

Submit an Adjustment to Correct Claims Partially Denied by Automated LCD-NCD Denials NGS would like to remind providers that using adjustment reason code “LN” to submit adjusted claims (xx7, xxQ), where changes were made to an LCD/NCD denied [...]

Screen Movements

  Chapter III: Navigating the Online System Screen Movements Purpose To move within the FISS/DDE Provider Online System, providers will perform several different screen movements. The following chart outlines the various screen [...]

MLN Connects® Newsletter for Thursday, August 18, 2022

MLN Connects® Newsletter for Thursday, August 18, 2022 Discontinuing Use of Certificates of Medical Necessity & Durable Medical Equipment Information Forms    News CMS Discontinuing the Use of Certificates of Medical [...]

Accessibility Statement

Accessibility Features of the National Government Services Website The NGSMedicare.com website employs many features to make information more accessible. If you have comments or suggestions, please use our Site Feedback mechanism to let us [...]

MLN Connects® Special Edition for Thursday, August 18, 2022

MLN Connects® Special Edition for Thursday, August 18, 2022 Creating a Roadmap for the End of the COVID-19 Public Health Emergency News Creating a Roadmap for the End of the COVID-19 Public Health Emergency Health Care System Resiliency [...]

New Version of PC-ACE: April 2025

New Version of PC-ACE: April 2025 PC-ACE Version 6.6 contains several CMS mandates and product enhancements including but not limited to the items listed below. 13891 – Implement Operating Rules – Phase III Electronic Remittance Advice [...]

Illinois, Minnesota, Wisconsin

Member Name Group Email Aldrich, Elizabeth IPW (Independent Physicians of Wisconsin), Allen Family Practice ealdrich@ipw-offices.org Anderson, Benita Aurora Health Care Benita.Anderson@aurora.org [...]

NGSConnex: Initiating and Checking Status of Reconsiderations

Did you know that you can save time and money by requesting a reconsideration via NGSConnex? When you submit reconsideration requests electronically using NGSConnex, you no longer need to complete a form, copy documentation and waste time with [...]

Exemption Process for the Prior Authorization Program for Certain Hospital Outpatient Department Services

The Centers for Medicare & Medicaid Services (CMS) implemented a prior authorization program for certain hospital outpatient department (OPD) services for date of service (DOS) on or after 7/1/2020 and subsequently added an exemption [...]

Let’s Chat: Prior Authorization for Certain Hospital Outpatient Department Services

This Let’s Chat session focuses on Prior Authorization for certain hospital outpatient department (OPD) services and is an informal opportunity for you to chat with our staff about the selected topic. During the session, you may ask us [...]

Counseling to Prevent Tobacco Use

In an effort to raise awareness and increase utilization of tobacco use counseling, we’ll focus on the effects of nicotine dependence including affected health consequences during this webinar. Medicare coverage, coding, billing and [...]

Part B Medicare Administrative Contractor Overview and Coverage for Dental Services

Medicare covers a limited number of dental services. The purpose of this webinar is to familiarize dental providers with National Government Services (NGS) and Medicare Part B dental coverage. Discussion will include an overview of the NGS [...]

Medicare Physician Fee Schedule Database

Medicare offers several tools to help providers bill their services. Many questions you have can be answered by learning how to access and use the Medicare Physician Fee Schedule Database. We hope you'll join us for an overview of this database.

Medicare Part B Ambulance Coverage, Basics and Billing

During this webinar, we'll educate new staff or those needing a refresher on basic Medicare Part B ambulance billing guidelines.

Top J6 Part B Claim Errors are Available

Top J6 Part B Claim Errors are Available We conduct a comprehensive data analysis on a quarterly basis to update and disseminate the latest insights on the most common claim errors. This initiative provides: Claim Error Reason Code [...]

Coverage Criteria and Frequency Limits

Coverage Criteria and Frequency Limits Table of Contents Counseling to Prevent Tobacco Use Diagnosis Coding Cost Sharing Reimbursement Nonparticipating Providers Related Content [Return to Top] Counseling to Prevent Tobacco Use [...]

Counseling to Prevent Tobacco Use and Tobacco Related Diseases Job Aid

April 2025 EDI Front End Quarterly Release

April 2025 EDI Front End Quarterly Release Please be advised that while the Centers for Medicare & Medicaid Services mandated release for April 2025 was installed the weekend of 4/6/2025, the code set updates included with this release [...]

Social Security Income Ratios

Social Security Income Ratios The federal fiscal year 2023 SSI ratios for IPPS hospitals, IRF and LTCH were posted on the CMS website. IPPS IRF LTCH NGS will update the latest published 2023 SSI ratios in the Provider Specific File of [...]

U5220

Avoiding/Correcting This Error Verify the MBI and date(s) of service. If services were provided prior to the date the beneficiary was entitled to Medicare, no further action is necessary. Otherwise, correct and resubmit.

34293

Avoiding/Correcting This Error Review your beneficiary’s enrollment in a Medicare HMO/MAO prior to providing services. A beneficiary may drop MAO coverage; review the CWF, IVR, NGSConnex, or HETS to identify a termination date for the MAO [...]

U538Q

Avoiding/Correcting This Error Medicare does not pay for medical items/services furnished to an alien beneficiary who was not lawfully present in the United States on the date of service that the items/services were furnished. Related Content [...]