Reason Codes

Chapter I: Online System Terminology Reason Codes Purpose Reason codes direct the outcome of an edit or process within FISS—they are the traffic cops of the system. Each reason code, when assigned, sends the claim to a specific [...]

View a Report (R2)

Chapter VII: Online Reports View Submenu (04) View a Report (R2) Purpose This option allows the provider to go directly to MAP1661 for report viewing. Task To access the View a Report option from the Fiscal Intermediary (FISS)/Direct [...]

FISS UB-04 Data Entry Payer Codes

Resources FISS UB-04 Data Entry Payer Codes The following payer codes may be reported in the CD field on CLAIM PAGE 03 of the online UB-04 claim entry record. Payer Code Description 1 Medicaid 2 Blue [...]

How to Adjust a Claim

Resources How to Adjust a Claim To adjust a claim using the FISS/DDE Provider Online System, follow these steps: Step Action 1 Select the CLAIMS CORRECTION (03) submenu from the MAIN MENU 2 Key the [...]

FISS Claim Change/Condition Reason Codes

Resources FISS Claim Change/Condition Reason Codes The following adjustment/cancel claim change reason codes may be reported in the COND CODE field on CLAIM PAGE 01 of the adjustment/cancel claim record. For Adjustment Claims Only (TOB [...]

How to Cancel a Claim

Resources How to Cancel a Claim To cancel a claim on the FISS/DDE Provider Online System, follow these steps: Step Action 1 Select the CLAIMS CORRECTION (03) submenu from the MAIN MENU 2 Key the [...]

Online System Menu Quick-Reference

Resources Online System Menu Quick-Reference Main Menu Inquires Submenu (01) Claims/Attachments Submenu (02) 01 – Inquires 02 – Claims/Attachments 03 – Claims Correction 04 – Online Reports View 10 [...]

Document Control Number

Chapter I: Online System Terminology Document Control Number Purpose The FISS DDE Provider Online System refers to the claim control number as a DCN. The DCN provides a reference number for the control and monitoring of each claim. To [...]

LCD, Billing and Coding Article Updates for August 2023

LCD, Billing and Coding Article Updates for August 2023 New LCDs and Articles (Effective 8/1/2023) Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin [...]

Text Telephone Changes

Text Telephone Changes TTY-based Telecommunications Relay Services permit persons with a hearing or speech disability to use the telephone system via a TTY or other device to call persons with or without such disabilities. To make using TRS as [...]

Ordering DMEPOS Items

MLN Connects® Newsletter: 5 Final FY 2024 Payment Rules — Aug 1, 2023

MLN Connects® Newsletter: 5 Final FY 2024 Payment Rules — Aug 1, 2023 Final FY 2024 Payment Rules New CMS Rule Promotes High-Quality Care and Rewards Hospitals that Deliver High-Quality Care to Underserved Populations Hospice Payment Rate [...]

Additional Documentation Request (ADR) Quick Reference Guide

MLN Connects® Newsletter: August 3, 2023

MLN Connects® Newsletter: August 3, 2023 News Medicare Dementia Care Model Your Patient’s Medicare Beneficiary Identifier (MBI) May Change CMS Roundup (July 28, 2023) Building on CMS's Accountable Care Vision to Improve Care for Medicare [...]

RA Top Page

Enter the date of the RA demand letter in the displayed format. The calculator will determine the time frames for RA activities.

Recovery Auditor Timeliness Calculator

CMS Waivers and Services Impacted by End of the Public Health Emergency

MLN Connects® Newsletter: January 26, 2023

MLN Connects® Newsletter: January 26, 2023 News Medicare Enrollment in PECOS: Faster and Easier Application Process — Coming Summer 2023 Medicare Enrollment: Maintain the Same Owners in All Enrollment Records Hospitals: Revised [...]

MLN Connects® Newsletter: 4 Proposed FY 2024 Payment Rules — April 4, 2023

MLN Connects® Newsletter: 4 Proposed FY 2024 Payment Rules — April 4, 2023 Proposed Rules FY 2024 Hospice Payment Rate Update Proposed Rule (CMS-1787-P) FY 2024 Medicare Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) [...]

MLN Connects® Newsletter: OPPS/ASC and PFS Final Payment Rules

MLN Connects® Newsletter: OPPS/ASC and PFS Final Payment Rules Final Rules   Final Rules HHS Continues Biden-Harris Administration Progress in Promoting Health Equity in Rural Care Access Through Outpatient Hospital and Surgical [...]

MLN Connects® Newsletter for Thursday, September 8, 2022

MLN Connects® Newsletter for Thursday, September 8, 2022 Prostate Cancer: Talk to Your Patients about Screening News Short-Term Acute Care Hospitals: Program for Evaluating Payment Patterns Electronic Reports Prostate Cancer: Talk to [...]

Part A Electronic Medicare Secondary and Tertiary Payer Specifications for ANSI Inbound Claim

Resources Part A Electronic Medicare Secondary and Tertiary Payer Specifications for ANSI Inbound Claims The following information is intended to provide you and your software vendor with a reference for electronically billing MSP and MTP [...]

Electronic Medicare Secondary Payer Specifications for Inbound Claims

Resources Electronic Medicare Secondary Payer Specifications for Inbound Claims The following information is intended to provide you and your software vendor with a reference point for electronically billing MSP claims. Use this information [...]

End-Stage Renal Disease: Medicare Part A Quick Reference Manual

CMS FQHC and RHC Flexibilities to Fight COVID-19 Update

EDI Application Status Search Tool

End-Stage Renal Disease: Medicare Part A Quick Reference Manual

Physician Dialysis Services

Accessing NGSConnex from Outside the United States or US Territories

Accessing NGSConnex from Outside the United States or US Territories We have security protocols to safeguard PHI and PII any time someone accesses the NGSConnex portal from outside the United States. If you access NGSConnex from outside the [...]

Chronic Disease Management and Preventive Services Learning and Action Series

Chronic Disease Management and Preventive Services Learning and Action Series A Collaborative Learning Opportunity with the Medicare Administrative Contractors National Government Services, Novitas Solutions, Wisconsin Physician Services [...]

Claims/Attachments Submenu

  Chapter II: Online Menu Functions Overview Claims/Attachments Submenu Purpose The CLAIMS/ATTACHMENTS submenu is primarily used for data entry of claims. Influenza virus vaccine, pneumococcal pneumonia vaccine and COVID-19 vaccine [...]

Check Search

Check Search Select the Financials button on the home page. In the Select a Provider panel, click the Select button next to the applicable provider account. Select Checks/EFT or Special Checks from the Financial Options drop-down [...]

View Checks and Special Checks Search

View Checks and Special Checks Search Select the Financials button on the home page. In the Select a Provider panel, click the Select button next to the applicable provider account. Select Checks/EFT or Special Checks from the [...]

Reminder: Submitting Paper Claims

Reminder: Submitting Paper Claims All paper claims are required to be submitted on the original red/white CMS-1500 (02/12) claim form. To ensure our OCR system can process claims efficiently: Use Courier New font for computer-generated [...]

Hot Topics

Online Menu Selection Quick-Reference Guide

Chapter II: Online Menu Functions Overview Online Menu Selection Quick-Reference Guide Main Menu Option 01: Inquiries Main Menu Option 02: Claims/ Attachments Main Menu Option 03: Claims Correction Main Menu Option 04: [...]

Medicare Fee-for-Service Claims and the Sequestration Payment Adjustment Changes

Medicare Fee-for-Service Claims and the Sequestration Payment Adjustment Changes Just a reminder: The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare fee-for-service claims. As a result of [...]

MLN Connects® Newsletter: August 10, 2023

MLN Connects® Newsletter: August 10, 2023 News Immunization: Protect Your Patients Claims, Pricers, & Codes Outpatient Rehabilitation Claims with Reason Code W7072: Do You Need to Resubmit Claims? MLN Matters® Articles HCPCS [...]

Claim Summary (12)

Chapter IV: Inquiries Submenu (01) Claims Summary (12) Purpose The CLAIM SUMMARY option allows providers to access specific data from the claim record for pending and processed claims. Note: Claim Summary is an “inquiry-only” option. You [...]

ZIP Code File (19)

Chapter IV: Inquiries Submenu (01) ZIP Code File (19) Purpose A ZIP Code is a five-digit numeric code used to identify a provider’s location. The ZIP CODE FILE option allows you to verify the validity of the facility ZIP Code that may be [...]

OSC Repository Inquiry (1A)

Chapter IV: Inquiries Submenu (01) OSC Repository Inquiry (1A) Purpose An occurrence span code identifies a specific event that relates to the payment of the claim that spans several days. The dates identify the commencement and ending of [...]

Home Health Payment Totals (67)

Chapter IV: Inquiries Submenu (01) Home Health Payment Totals (67) Purpose This option is currently unavailable. Revised 8/16/2023

ANSI Reason Codes (68)

Chapter IV: Inquiries Submenu (01) ANSI Reason Codes (68) Purpose ANSI codes are used to explain the adjudication of a claim and are the CMS approved ANSI messages. ANSI reason codes and CMS message codes will appear in the body of the [...]

Check History (FI)

Chapter IV: Inquiries Submenu (01) Check History (FI) Purpose The CHECK HISTORY option allows providers to view their last three Medicare checks (payments). To access the CHECK HISTORY option from the FISS Online System INQUIRIES [...]

Beneficiary/CWF (10)

Chapter IV: Inquiries Submenu (01) Beneficiary/CWF (10) Purpose The purpose of the beneficiary screens is to provide access to all beneficiaries contained on the eligibility file. The provider can use this file to verify beneficiary data. [...]

MLN Connects® Newsletter: August 17, 2023

MLN Connects® Newsletter: August 17, 2023 News CMS.gov Website Refresh – Test Website Available for Feedback CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in Hawaii Due to Recent Wildfires Clotting [...]

Tracking my Enrollment Packet and Checking Status

Tracking my Enrollment Packet Once your packet is submitted (See the section on Submitting the Packet), a confirmation message is displayed on the screen with the assigned Packet ID (PID) number. The PID will be sent to the e-mail address [...]

I Am a Billing Service and “I Want to Connect Directly to the Part A FISS/DDE System”

I Am a Billing Service and “I Want to Connect Directly to the Part A FISS/DDE System” This selection will prompt you to complete the Logon Request Form. This option is for a third party who wishes to update an operator's contact information, [...]

Customer Experience Surveys

Customer Experience Surveys We are pleased to offer two new surveys for you to tell us about your experience with our Provider Contact Center. When you use our IVR system, access the survey from the main menu after you complete your [...]

Appeals

Appeals State MAC Appeals Address Qualified Independent Contractor Address and Phone Number Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Nevada, Northern Mariana Island, Oregon, [...]

Medicare Rights & Protections

Medicare Rights & Protections Appeals Process Quality of Care Complaints Quality Care Finder – Compare Health Care Providers and Plans

Prolonged Services: Comparative Differences of Face-to-Face/Non Face-to-Face CPT Codes

Prolonged Services: Comparative Differences Face-to-Face vs. Non Face-to-Face CPT Codes Face-to-Face ( CPT Codes 99354-99355, 99356-99357) Non Face-to-Face (CPT Codes 99358-99359) Have been [...]

Prolonged Services: Face-to-Face

Prolonged Services: Face-to-Face Coding Guidelines Counseling and Coordination of Care Office versus Hospital Setting Excluded Time Examples NGS JK MAC has noted an increase in claims representing face-to-face prolonged [...]

Tips to Ensure an Optimal NGSMedicare.com Experience

Tips to Ensure an Optimal NGSMedicare.com Experience Most of you are probably aware, but if not, on Friday, 5/14/2021, we launched our new combined homepage. These changes were a result of your feedback. You now only need to go to [...]

Skilled Nursing Facility Patient Driven Payment Model Billing For Noncovered Days With An Occurrence Span Code 76

Skilled Nursing Facility Patient Driven Payment Model Billing For Noncovered Days With An Occurrence Span Code 76 The CR 11992 updated the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Sections 40.3.2 and 40.6 to [...]

FQHC PPS Calculator

There’s Still Time to Register – National Government Services Preventive Service Week

There’s Still Time to Register – National Government Services Preventive Service Week National Government Services Provider Outreach and Education Team is holding a Special Virtual Conference on Medicare Preventive Services. Join us on [...]

Testosterone Pellet Dosage

Testosterone Pellet Dosage The dosage approved by the US Food and Drug Administration for testosterone pellet replacement therapy in androgen-deficient males is 150 mg to 450 mg subcutaneously every 3-6 months. Effective for dates of [...]

Register for EDI