© 2011 Copyright, CGS Administrators, LLC.Revised June 14, 2011. 1 Kentucky Part B Providers.

Revised June 14, 2011.

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© 2011 Copyright, CGS Administrators, LLC.

Kentucky Part B Providers


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Acquisition NewsAcquisition News

BlueCross BlueShield of South Carolina has acquired CIGNA Government Services, LLC.

While very little will change as a result of the acquisition, we have changed our name!

As of June 1, 2011, we are legally known as CGS Administrators, LLC.


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AgendaAgenda

J15 Transition Action Items

KY Part B Operational Contacts

Resources


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J15 Kentucky Part B Action ItemsJ15 Kentucky Part B Action Items

Electronic Funds Transfer

Electronic Data Interchange

J15 ListServ

Local Coverage Determinations


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Electronic Funds Transfer (EFT)Electronic Funds Transfer (EFT)

Have you received an EFT from CGS?

CGS needs your Re-enrollment CMS 588 application to eliminate an interruption of your cash flow.

The CMS 588 application can be found at: http://www.cms.gov/cmsforms/downloads/CMS588.pdf

Need help completing the CMS 588 application, visit CGS’ EFT Web-based tutorial: https://www.cgsmedicare.com/captivate/J15588/CMS588Form.htm


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Paper ChecksPaper Checks

If you received paper checks from NGS no additional steps are required.

Once the claims have been on the payment floor, for the appropriate time, the paper checks will be issued to the “Pay To” address.


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J15 Kentucky J15 Kentucky Electronic Data Interchange (EDI)Electronic Data Interchange (EDI)

CGS is subcontracting with National Government Services to continue to support the Kentucky Part B EDI workload on the current EDI Gateway.

What does this mean for the Kentucky Part B provider community? • There will be no change for your connectivity or transmission of EDI

transactions for the J15 A/B MAC.

• Continue sending your claims and receiving your remittances to and from the same system.


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Effective April 30, 2011, through September 30, 2011, Kentucky Part B EDI Trading partners will continue to use the current National Government Services EDI Help Desk phone number, 1.877.273.4334 and email option, [email protected].

When calling the Help Desk, there will be a selection specifically for the Kentucky Part B EDI trading partners. For EDI Enrollment activities, providers will continue to use the EDI Enrollment application available from the NGS website.



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For 5010 testing/production implementation, Kentucky Part B trading partners will follow the NGS HIPAA 5010 Companion Guide.

The Companion Guide will have specific references to J15, as applicable. For inquiries regarding 5010 testing, please use the Email Inquiry Form under 'Contact Us' on the NGS website: http://www.ngsmedicare.com.


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J15 ListServJ15 ListServ

Our ListServ is the fastest and easiest way we can communicate news and information related to J15 transition activities.

New Customers may register at: http://www.cgsmedicare.com/medicare_dynamic/ls/001.asp


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http://www.cgsmedicare.com/medicare_dynamic/ls/001.asp

J15 ListServJ15 ListServ


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J15 Local Coverage J15 Local Coverage Determinations (LCDs)Determinations (LCDs)

• CGS has worked closely with NGS to identify and consolidate current LCDs.

• The LCDs are available on our website at: http://www.cgsmedicare.com/kyb/coverage/lcd/index.html • We strongly encourage you to closely review and familiar yourselves

with all LCDs that will govern the types of services you provide.


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Kentucky Part B LCDsKentucky Part B LCDs

Remember, the effective date for CGS Kentucky Part B LCDs is April 30, 2011.

Note: Services will be adjudicated based on their date of service. If CGS receives a claim with the date of service 02/13/2011, NGS’ LCDs would apply.


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LCD CrosswalkLCD Crosswalk

In an effort to assist you in understanding the key differences between LCDs you

are use to following and those that CGS currently use as

of April 30, 2011, we have developed an LCD crosswalk.

It is available here: http://www.cgsmedicare.com/j15/LCDCrossWalk.xls


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J15 Kentucky Part B J15 Kentucky Part B Operational ContactsOperational Contacts


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Interactive Voice Response (IVR)Interactive Voice Response (IVR)

The Centers for Medicare & Medicaid Services (CMS) requires providers to utilize the Interactive Voice Response (IVR) System to check the status of claims.

The IVR offers a host of self-service options, including claim status, patient eligibility, check status and more. Remember, CMS requires providers to use the IVR for these simple inquiries. • KY Part B IVR: 1.866.290.4036

– The IVR is available 24 hours a day, 7 days a week, except for routine system maintenance

– For inquires requiring access to the online system, the times below represent our online system availability:

» Monday - Friday: 7:00am - 7:00 pm ET» Saturday: 7:00 am - 4:00 pm ET


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J15 Part B User GuideJ15 Part B User Guide

http://www.cgsmedicare.com/kyb/claims/ivr/PartB_IVR_user_guide.pdf


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J15 Part B Provider Contact Center (PCC)J15 Part B Provider Contact Center (PCC)

For complex inquires that cannot be handled via the IVR and require the assistance of a Customer Service Representative, providers may call our Customer Service unit. • Telephone Inquires: 1.866.276.9558

Customer Service is available: • Monday - Friday: 8:00 am to 5:00 pm (ET)

• TTY/ TDD: 1.888.270.9481


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J15 Part B Provider Contact Center (PCC)J15 Part B Provider Contact Center (PCC)

There is a Three level Tier Process for the PCC• Tier I: General inquires

• Tier 2: Escalated Inquires

• Tier 3: Complex Inquires (Handled by the Provider Relations

Research Analyst) PRRS has up to 45 days to respond to

inquires, verbal or written.


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Paper Claim Paper Claim Submission/General CorrespondenceSubmission/General Correspondence

For all general correspondence, including the submission of paper claims, please use the following mailing address:

CGS1 Cameron Hill Circle Suite 0060Chattanooga, TN 37402-0060


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AppealsAppeals

The first level of Appeals is Redeterminations. Send Redeterminations to:

CGS1 Cameron Hill Circle Suite 0061Chattanooga, TN 37402-0061

All Redeterminations must be received within 120 days of the initial determination.


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ReopeningsReopenings

“Reopenings” is a process used to correct minor errors or omissions to a previously processed claim without using the formal appeals process.

A reopening must be requested within one year from the date of the initial determination.


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ReopeningsReopenings

Reopenings can be received via telephone, fax and/or written correspondence: • Send the Written Reopening form to:

– Address: CGS1 Cameron Hill CircleSuite 0061 Chattanooga, TN 37402-0061

– Telephone Reopenings: 1.855.273.7616

– Fax: 1.615.664.5914

– Web: http://www.cgsmedicare.com/kyb/forms/gateways/reopenings.html


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Provider EnrollmentProvider Enrollment

Provider Enrollment primary responsibilities are credentialing and enrollment of Medicare Provider records.• Telephone inquiries will be handled by the PCC at: 1.866.276.9558.

Escalated inquires will be forwarded directly to the Provider Enrollment department.

Provider Enrollment address:CGS1 Cameron Hill CircleSuite 0062 Chattanooga, TN 37402-0062


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Overpayment RecoveryOverpayment Recovery

Overpayment Recovery handles voluntary refunds, offsets, and lost checks

Mailing Address for Refund checks: CGS J15 Part B Kentucky PO Box 957065 St. Louis, MO 63195-7065


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ResourcesResources


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CMS ResourcesCMS Resources

CMS provides numerous resources to assist providers!• CMS website

– Internet-Only Manual System

– Medicare Coverage Data Base

– Fee Schedules

– MLN Matters Articles

• Open Door Forum Calls

• ListServ (Email)

• CMS Transmittals


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CMS WebsiteCMS Website

http://www.cms.gov/ • Take full advantage of Top 10 Links!!


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MLN Matters ArticlesMLN Matters Articles

http://www.cms.gov/MLNMattersArticles/

What are MLN Matters Articles?• National Articles Helping Providers Understand New

or Changed Medicare Policy

• User-friendly format

• Explain provider action needed


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CGS ResourcesCGS Resources

Provide a number of resources to assist you:• CGS website

– CGS Home

– DME MAC Jurisdiction C

– Home Health & Hospice

– ID Part B Homepage

– KY Part B Homepage

– Ohio Part B Homepage

• Contact US

• ListServ

• Helpful Links


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CGS CGS Kentucky Part B WebsiteKentucky Part B Website

http://www.cgsmedicare.com/kyb/index.html


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KY Part B HomepageKY Part B Homepage

Contains links to relevant information for Part B providers:• Claims Processing

• Coverage & Pricing

• Education

• Provider Enrollment

• FAQs

• Forms

• News & Publications

• Tools & Site Map

• Customer Service


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Online Help CenterOnline Help Center

Complex inquiries:• Utilize for inquiries

requiring research

– Receive an email response from subject matter experts

– Response within 45 business days

http://www.cgsmedicare.com/kyb/help/contact/onlinehelpJ15.html


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Questions?Questions?

© 2011 Copyright, CGS Administrators, LLC.Revised June 14, 2011. 1 Kentucky Part B Providers.

Documents

Transcript of © 2011 Copyright, CGS Administrators, LLC.Revised June 14, 2011. 1 Kentucky Part B Providers.