Medicare dmepos manual

Note that if a claim is eligible for a simple claim correction, then using the Claim Correction screen in myCGS is the fastest and easiest way to reopen and correct your claim. Refer to the Claim Correction section below.

You should use the Reopenings Form Submission only when a simple claim correction is not an option. In order to initiate your request, the original claim in question must have already completed processing and must be eligible for a Reopening. If a Reopening cannot be requested for the claim you select for any reason, you will receive an error message with instructions.

To submit a Reopening in myCGS, follow the steps below. The first step in requesting a Reopening in myCGS is to select the claim or claims you wish to include in your request. You can find your claim using either a regular Claim Status search via the Claims menu—refer to the Claims section in this manual or through the Reopenings Form Submission screen in the Reprocessing menu.

Either method will take you to the same Reopenings Request Form after you have found and selected your claim. From the Claim Status screen , select your claim s by pressing the Reopenings button on the Claim Status Summary screen. After pressing the Reopenings button, you must select the claim lines you wish to include in your request. This will take you to the Reopenings Request Form. Complete the rest of the form just as you would complete the paper version of the Reopenings Request Form.

After pressing the Submit button, your request will be submitted to CGS and processed just like a Reopenings request that was submitted via mail or fax. You can check the status of your request using the Reopenings Status screen. This is similar to a telephone reopening, but done in the web portal instead of over the phone. Only simple corrections can be made through this process. For more complicated claim adjustments or for a claim appeal, you will need to submit a reopening or redetermination request whichever is appropriate for the situation.

Corrections to diagnosis codes must be submitted through Redeterminations. In order to initiate a claim correction, the original claim must have already completed processing. If the claim is still in process, you must wait for it to complete processing before submitting a correction. Duplicate claims and claims which have already had an adjustment initiated through a reopening, appeal, or other adjustment process are not eligible for correction in myCGS.

Claims that completed processing over one year ago are not eligible for correction. To initiate a claim correction in myCGS, follow the steps below.

You can find your claim using either a regular Claim Status search via the Claims menu—refer to the Claims section in this manual or through the Claim Correction screen in the Reprocessing menu.

Either method will take you to the same Claim Correction screen after you have found and selected your claim. If you begin on the Claim Status screen, search for your claim as you normally would when checking claim status, and then press the Claim Correction button on the Claim Status Summary screen. If you begin on the Claim Correction screen, search for your claim using the same data as you would when searching for claim status. The Claim Correction search screen behaves exactly the same way as the Claim Status screen.

Once you have found your claim, press the Claim Correction button. After you have found the claim that needs correction and pressed the Claim Correction button, you will be taken to the Claim Correction screen, where you can make your request. Once you're on the Claim Correction screen, myCGS will present the claim that you've selected for adjustment. All fields that are eligible for correction will be editable. Make as many changes to your claim as you need you must make at least one change.

After you have updated the field or fields you need to change, enter the reason why you are making the correction in the Reason for Claim Correction field. Please be sure to keep a copy of the confirmation number for your records. If you have a question about the adjusted claim and need to call Customer Service, you will need to reference the confirmation number. Use the print icon in the top right corner of the screen to print a copy or save a PDF of the confirmation screen.

You can press Enter if your cursor is in the Reason for Claim Correction field to create a paragraph break, but if your cursor is anywhere else on the screen, pressing Enter may submit your request. Be careful not to press Enter until you are ready to submit your claim correction, otherwise you may submit your request prematurely. Note that most reopening requests are completed in 10—14 days. When checking status, you can use the confirmation number you received as the DCN in your reopening search or you can search using the CCN.

When you search for claim status, you will see both your original claim and your adjusted claim. The adjusted claim will show the current status of your claim correction. Redeterminations Status The Redeterminations Status screen provides current status of redetermination requests that you have submitted to Jurisdiction B or C depending on the jurisdiction you have selected.

Reopenings Status The Reopenings Status screen provides current status of reopening requests that you have submitted to Jurisdiction B or C depending on the jurisdiction you have selected. The patient's first name, last name, date of birth, and social security number are required to get a unique match.

After entering all of the required information, check the box which says "I am not a robot. It also informs you of our holiday closure schedule. Currently this feature is used exclusively for Targeted Probe and Educate TPE cases in which you have already responded to an ADR request, but our Medical Review staff needs additional information for instance, when your ADR response did not include all requested documents or information.

When you receive a message, you have five business days to respond to the request; after 10 business days the message is deleted. When a message is generated to you by CGS staff, you will receive email notification from myCGS stating that you have a new message.

You cannot initiate a message yourself in myCGS, only respond to a message we have sent regarding a claim. End Users by default do not have access— DAs must specifically give End Users access to secure messaging in order for them to access the inbox.

To access your inbox, select the inbox icon in the top-right corner of your screen you can access your inbox whether you have any unread messages or not.

Note that the inbox itself is jurisdiction-neutral, meaning it doesn't matter if you are currently logged into Jurisdiction B or Jurisdiction C.

From the inbox, you will see the following information for each message you have:. Click on the desired message to open it.

If you hover your cursor over the message, you will also have the option of a quick reply or delete button. After selecting a message, a popup window will appear on your screen showing you the full message, as well as the following information about the message and claim in question:. Please respond to all messages sent to you within five business days. All messages are automatically deleted from myCGS 10 business days after they are sent to you. Note that "business days" are Mondays through Fridays; holidays are not taken into account.

To respond to a message in myCGS, press the Reply button. The Secure Message Form window will appear, where you can enter text and attach documents. All responses must include at least one attachment. Enter any message you wish to include in the "Message" text box up to characters , and then press the Browse button to add your attachments. After selecting your documents, myCGS will list the files you have ready to submit.

If you wish to save a copy of your response, press the Export button to save your message as a PDF. After pressing Submit, a popup message will appear asking if you have attached all of your documentation. You will receive a message confirming your response with the time and date of the submission. Note that the daily response cut off time is pm Central Time—any response submitted after pm Central Time is considered to be received the following business day.

CGS staff will then review your response and process the claim appropriately. If you wish to view your response after you have submitted, open the message from your inbox again. You will notice that the Reply button has changed to a My Response button.

Press the My Response button to view your response. You will then also be able to export your response if you did not do so previously. Accessing your Inbox To access your inbox, select the inbox icon in the top-right corner of your screen you can access your inbox whether you have any unread messages or not. Viewing Messages After selecting a message, a popup window will appear on your screen showing you the full message, as well as the following information about the message and claim in question:.

There are several options in the My Account menu, including:. When you are finished viewing any screen within the My Account section, select the Home menu to return to the myCGS home page, where you can continue to use the functions and features of myCGS. Passwords are an important part of securing both beneficiary data and your company's data.

Your myCGS password should be kept up to date changed every 60 days and should be known only to you. Your account will be locked if you enter your password incorrectly three consecutive times within a minute period. We recommend that if you have two consecutive unsuccessful login attempts that you do one of the following to prevent being locked out:. When you change your password, you cannot reuse any of your previous 12 passwords.

Additionally, your new password must contain at least six different characters than your previous password, or if you reuse the same characters, they must be in a different position in the password. For example, if your previous password started with the letter P, your new password should start with a different character, but you can still use the letter P in a different position of the password. If you attempt to change to a new password of Portal 92, myCGS will give you an error message stating that you need to use different characters for your password.

This is due to the fact that six characters "Portal" are the same characters in the same position as your previous password. If you instead change your password to Latrop 92, this password would be accepted because even though six of the same characters are reused, they are in different positions.

Note that myCGS includes an optional suggested password in case you are having difficulty creating your own password see the Password Suggestion section below. When changing your password, myCGS offers an optional "password suggestion" that you can use as your new password. To use the password suggestion, follow these steps:. We recommend that you set up at least two forms of MFA so that you always have a backup. If you use a cell phone carrier other than one of the four service providers listed, choose the service provider network which is used by your carrier to provide service.

If you are unsure of the network, please contact your carrier. If you choose the wrong service provider, you will not receive MFA text messages. If you choose to use Google Authenticator, you will need to either download the Google Authenticator app on your smart device phone, tablet, etc. There are also third-party applications that can give you access to Google Authenticator CGS does not provide advice on use of third-party applications. Check with your management to see if Google Authenticator can be made available to you.

To use Google Authenticator, first download the appropriate app on your smart device, or download the web browser extension:. Follow the instructions in your Google Authenticator app or web extension to scan the QR code, or manually enter the code.

To view your provider profile, select the Provider Profile option in the My Account menu. Any changes to your supplier information must be made through the appropriate entity i. Once you are finished viewing your provider profile, press the Home menu to return to the main functional areas of myCGS. To view your basic user profile information such as your address or telephone number , select the User Account option in the My Account menu. The User Info screen will appear, showing your basic contact information.

Changing the email address your User Account does not affect the email address in your MFA settings and vice versa. End Users do not act for or on behalf of the CMS. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third-party beneficiary to this license.

All rights reserved. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories.

You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Please click here to see all U. Government Rights Provisions.

CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT and other content contained therein, is with insert name of applicable entity or the CMS; and no endorsement by the ADA is intended or implied.

This Agreement will terminate upon notice to you if you violate the terms of this Agreement. End Users do not act for or on behalf of the CMS. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

All rights reserved. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Join Electronic Mailing List. The files offered below are in Adobe PDF format. No fee schedules, basic unit, relative values or related listings are included in CDT The ADA does not directly or indirectly practice medicine or dispense dental services.

The sole responsibility for the software, including any CDT-4 and other content contained therein, is with insert name of applicable entity or the CMS; and no endorsement by the ADA is intended or implied. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.

The scope of this license is determined by the ADA, the copyright holder. End users do not act for or on behalf of the CMS. File or Directory not found The resource you are looking for might have been removed, had its name changed, or is temporarily unavailable.