Will there be a minimal amount of time between SI joint steroid injections?

Why is radiofrequency ablation (RFA) noncovered?

Are the radiofrequency ablations allowed now until 3/20/2023, or are already noncovered?

For patients who are already receiving treatment do they need to repeat diagnostic procedures under the new policy?

How can provider access post injection pain after the injection?

We are in a group of eight physicians. What if the patient saw a different physician in clinic and a different physician is doing injection. Is that okay?

Can SIJIs be performed under sedation? How about monitored anesthesia care (MAC)? Is “twilight” allowed?

We receive referrals for an injection with detailed chart notes, does our provider need to see and examine the patient again?

Don't use G0260 only applies to POS 49? So, regardless of facility type, G0260 no longer needs to be used? And Is G0260 still fine to bill for an ASC or will they now just have 27096 for facility & should be billed with POS 24 and bill G0260 for our SIJI on the facility side?

Many patients have degeneration throughout the spine does that justify need for multiple procedures in same session?

Will prior authorization be required?

How many injections per calendar year?

Can sacroiliac joint injections be performed bilaterally?

If SIJ is injected on right and then determined to inject the left side in another session does that count as bilateral?

How do we report unilateral vs. bilateral injections?

If a SIJI is performed and a biological agent is added to the injected will the injection still be covered?

Can CRNAs perform these procedures?

What should be done if patient does not want to continue conservative treatment?

When does a pain scale or functional assessment need to be done?

Meeting Minutes

Meeting Minutes Jurisdiction 6 Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Island, Oregon, Puerto Rico, U.S. Virgin Islands, Washington and Wisconsin [...]

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the MAO/HMO entitlement dates. Outpatient facilities and IPPS and IRF hospitals, or LTCH billing services within an [...]

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS/DDE Provider Online System, HETS or NGSConnex to verify [...]

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Outpatient facilities and inpatient noninpatient PPS and IRF hospitals, or LTCH billing [...]

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider Online System, HETS or NGSConnex to verify beneficiary [...]

7K073

Avoiding/Correcting This Error If the beneficiary is entitled to Medicare Part B, an ancillary claim may be submitted to your MAC. Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]

38032

Avoiding/Correcting This Error If duplicate claim was submitted in error, no additional provider action is necessary. If it is determined that the claim was due to additional charges for a patient for a specific date of service, wait for the [...]

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider [...]

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

C7010

Avoiding/Correcting This Error If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient). Verify hospice enrollment prior to claim submission by reviewing the CWF, HETS [...]

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

7K073

Avoiding/Correcting This Error If the beneficiary is entitled to Medicare Part B, an ancillary claim may be submitted to your MAC. Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) [...]

38105

Avoiding/Correcting This Error Verify billing and if appropriate, correct and resubmit the claim.   To prevent this error on future claims: Ensure that the correct bill type is submitted once you have received all charges from all [...]

38032

Avoiding/Correcting This Error If duplicate claim was submitted in error, no additional provider action is necessary. If it is determined that the claim was due to additional charges for a patient for a specific date of service, wait for the [...]

38200

Avoiding/Correcting This Error Always verify the status of a submitted claim before submitting another claim. Verify claim status using the IVR system, FISS/DDE or the NGSConnex online portal. Per CMS mandate, PCC representatives are not [...]

38312

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim.   To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]

APPLICATION FEE: What is the amount of the application fee?

APPLICATION FEE: Who needs to pay an application fee?

APPLICATION STATUS: Where can I find the status of a submitted application?

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 Written Correspondence and Inquiries [...]

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 Written Correspondence and Inquiries [...]

ASCA: Where do we mail our Administrative Simplification Compliance Act (ASCA) waiver request?

ASCA: What kind of supporting documentation should I attach to my Administrative Simplification Compliance Act Waiver Request?

ASCA: When applying for an ASCA waiver, do I need to complete the Waiver Request form for each provider number?

ASCA: Must an Administrative Simplification Compliance Act waiver be mailed or can it be faxed?

ASCA: If my Administrative Simplification Compliance Act Waiver Request is denied, what will happen to my paper claims?

ASCA: How will the Administrative Simplification Compliance Act enforcement review affect me as a “small provider/supplier?” Will I be required to submit claims electronically?

ASCA: How will I know the outcome of my Administrative Simplification Compliance Act waiver request form?

ASCA: I was under Administrative Simplification Compliance Act review once and received an approved waiver request to send paper claims, why am I under review again?

DDE: How do I get my log on ID password reset?

CLAIMS: Why would my postoperative claims deny?

CLAIMS: Where are comments entered on the 837P electronic claim form?

CLAIMS: When submitting an ambulance claim, do the base and mileage codes need to have the same ZIP code for the same trip?

CLAIMS: What is the correct way to submit a beneficiary name on a claim?

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

CLAIMS: Medicare is the beneficiary's secondary payer and I am receiving denials when submitting using the CMS-1500 form. How can I resolve this?

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?