Current Frequently Asked Questions (FAQs)
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- How do I check the status of my claim?
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CMS requires the use self-service technology to obtain claim status and beneficiary eligibility information. Customer Service Representatives are not able to provide it.
CGS offers two self-service methods to check the status of a claim: through the myCGS Web portal or by calling the Interactive Voice Response (IVR) line.
The myCGS web portal is the easiest way to obtain claim status information, and much more. We have resources on the myCGS DME MAC Web Portal page to help you learn more.
For more information about the IVR and its abilities, please refer to the IVR System Script and User Guide
Published: 12.14.22
Reviewed: 03.28.24
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- What if my claim status is not on file?
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Only claims processed by DME MAC Jurisdictions B or C are available on the myCGS DME MAC web portal. Only claims processed by DME MAC Jurisdiction B are available on the JB Interactive Voice Response (IVR) line. Consider the following questions:
- Is the claim for durable medical equipment, prosthetics, orthotics, or supplies? If it is not for DMEPOS items, then it is possible the provider needs to check a different part of Medicare, like Part B. Supplier Manual Chapter 1 - Introduction explains the different part of Medicare.
- What jurisdiction is the beneficiary's address in? The beneficiary’s address on file with the Social Security Administration determines the claim jurisdiction. Send DMEPOS claims to the DME MAC jurisdiction for the state in which the beneficiary resides. Supplier Manual Chapter 15 – Resources lists four DME MAC jurisdictions with states and territories.
- What jurisdiction should the claim be in? The beneficiary may receive DME in a state different from their address on file.
- Was the claim submitted on paper or electronically? If it is a paper claim, we may not have received it or we may have rejected it. We publish claim submission guidelines in the Supplier Manual Chapter 6 - Claim Submission and Supplier Manual Chapter 8 – EDI.
If you filed the claim electronically, check with your software vendor, billing service or clearinghouse, if applicable. The CEDI (Common Electronic Data Interchange) contractor publishes information on the CEDI Contractor website about electronic claim front end edits and reports.
Published: 12.14.22
Reviewed: 03.28.24
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- How do I use myCGS?
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- If you're not yet registered for the myCGS portal, the myCGS Registration & Account Management Guide explains the enrollment process, password, security, and account maintenance requirements.
- The myCGS User Manual shows how to access different features of myCGS and how to keep your account secure.
- You can also review myCGS Questions & Answers (Q&As) and other resources on the myCGS DME MAC Web Portal page.
Published: 12.14.22
Reviewed: 03.28.24
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- What are the top Targeted, Probe and Educate (TPE) reasons for denial?
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We publish Medical Review Quarterly Reports for items under pre-payment review. Each report shows the top 10 reasons for claim denials for the policy or topic under review.
Published: 12.14.22
Reviewed: 03.28.24
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- Where can I find phone numbers and addresses for CGS and other Medicare contractors?
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We list addresses and phone numbers for CGS and other Medicare contractors here: Contact Information.
You can also find contact information for other DME MACs, and other Jurisdiction B resources, by referring to the DME MAC Supplier Manual, Chapter 15.
CMS publishes current maps and lists of Medicare Administrative Contractors here: Who are the MACs.
Published: 11.06.13
Reviewed: 03.28.24
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- Where can I find guidance on filing a claim?
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The Claim Submission page provides access to resources and education to help you submit a DMEPOS claim to Jurisdiction B.
Chapters 6 and 8 of the DME MAC Supplier Manual includes rules for mandatory claim submission, assignment, time limit, place of service, claim completion instructions, and much more.
Our Provider Outreach and Education (POE) team offers education on claim submission and other important topics. The POE calendar of events, online education courses, videos and other information is available on the Education and Outreach page .
Published: 11.08.13
Reviewed: 03.28.24
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- How do I find information about Medicare statutes and regulations?
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The DME MAC Jurisdiction B Supplier Manual provides an important overview of Medicare rules and regulations for DMEPOS suppliers. It is the first resource that you should use for Medicare billing questions. Also, subscribe to our electronic mailing list and monitor our news page for important updates regarding Medicare rules and regulations.
Published: 03.23.16
Reviewed: 03.28.24
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- Where can I find information on overpayments and refunds? Where can I get information related to a specific offset?
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Information regarding overpayments and refunds is in the DME MAC Jurisdiction B Supplier Manual, Chapter 12.
You can find information about specific offsets using either the myCGS web portal or the Jurisdiction B IVR.
To find offset information in myCGS, log in to myCGS, go to the Finance tab, and select the Offsets secondary tab. After entering the financial control number (FCN) of the offset from your Remittance Advice, myCGS will provide you with the original overpayment date, current offset balance (if any), name and MBI of the beneficiary on the original overpayment, and the date of service that was overpaid.
To obtain offset information from the IVR, press option 3 for Payment Information and 3 again for Offset Information. The IVR will ask you for your NPI, PTAN, last 5 digits of your tax identification number (TIN), and the FCN from your Remittance Advice. The IVR will provide you with the claim details of the original overpayment, as well as the overpayment letter date and current offset balance.
For more information about myCGS, including a myCGS Registration and Account Management Guide and mycgs User Manual to help you get started, visit our myCGS page.
For more information about the IVR and its abilities, visit the IVR System Script and User Guide.
Published: 11.08.13
Reviewed: 03.28.24
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- I need to find out if a beneficiary has had a specific item in the past (same or similar inquiry). What's the best way to find this information?
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The best way to obtain same or similar information is through the myCGS DME MAC web portal. The Same/Similar screen allows you to view a complete picture of a beneficiary's prior equipment history for a specific product category, including orthotics and prosthetics. You can also search by HCPCS code, partial HCPCS, or a range of codes. The myCGS User Manual explains how to use the Same/Similar search feature.
Same or similar information is available for some products in the Jurisdiction B IVR. The IVR will report the following information if there is same or similar equipment on file:
- Whether or not a CMN/DME information form (DIF) is on file, including the HCPCS code
- CMN/DIF initial date, revised date, and/or recertification date
- Length of need
- Number of months paid (if rented)
- Last paid date (if rented)
- Phone number of previous supplier (if rented)
Note: Customer service representatives (CSRs) are unable to release any extra information outside of what the IVR can provide.
For more information about the IVR and its abilities, please refer to the IVR System Script and User Guide.
Same or similar information for orthotics/prosthetics (L codes) is only available through myCGS or by written inquiry. CSRs are not able to provide claim history for orthotics/prosthetics.
Published: 11.08.13
Reviewed: 03.28.24
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- How can I determine if a beneficiary is enrolled in a Medicare Advantage Plan (MAP)?
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The easiest way to obtain Medicare Advantage Plan (MAP) information is through the myCGS DME MAC web portal. The Beneficiary Information tab shows detailed MAP information including historic information in a 16-month span.
For more information about myCGS, including a myCGS Registration and Account Management Guide and mycgs User Manual to help you get started, visit our myCGS page.
You can obtain MAP enrollment effective dates, name, and contract ID through the Jurisdiction B IVR. Press option 1 (Beneficiary Information) from the main menu, then option 1 (Beneficiary Eligibility) and follow the prompts. A list of names, addresses, and phone numbers for MAP contractors is on the CMS website.
For more information about the IVR and its abilities, please refer to the IVR System Script and User Guide.
Published: 11.08.13
Reviewed: 03.28.24
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- How can I check the status of my Redetermination request?
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You can check the status of a Redetermination by using the myCGS web portal or the Jurisdiction B IVR.
In myCGS, go to the Reprocessing tab. You can search for a Redetermination by either the document control number (DCN) of the case or the claim control number (CCN) of the claim. myCGS will then provide you with the date in which we received your request and the current status of the case, including whether it is pending, reversed, upheld, or dismissed.
To find Redetermination status on the IVR, select option 2 (claim information), followed by option 3 (Redetermination information), and then option 2 (Redetermination status).
To verify Redetermination status, you must provide your NPI, PTAN, last five digits of your tax identification number (TIN), the beneficiary's Medicare number, beneficiary's name, and the claim number (CCN, ICN) of the claim that is being appealed. The IVR will provide the status of your Redetermination request, including whether it is pending, reversed, upheld, or dismissed.
For more information about myCGS, including a myCGS Registration and Account Management Guide and mycgs User Manual to help you get started, visit our myCGS page.
For more information about the IVR and its abilities, please refer to IVR System Script and User Guide.
Published:11.08.13
Reviewed: 03.28.24
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- How do I use this website?
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We recorded a special video to demonstrate how to use our website. Watch the CGS Website Tutorial to learn how to navigate, find provider education materials, locate information, and understand different features.
Published: 12.14.22
Reviewed: 03.28.24
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- What if I receive a same/similar denial?
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Check out the following resources:
- If the item denied with ANSI Reason Code M3 – Supplier Manual Chapter 3, Section 13 explains how liability is assessed on same or similar denials.
- Repairs, maintenance, replacements, and reasonable useful lifetime (RUL) – Supplier Manual Chapter 3, Section 11 and Chapter 5, Section 9
- Same/Similar Code Lookup Tool – enter a HCPCS code in the search field to view a list of other HCPCS codes that may be considered the same as or similar to the base item entered.
Published: 12.30.22
Reviewed: 03.28.24
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- I received a medical necessity denial. What should I do next?
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Refer to the appropriate Local Coverage Determination (LCD) and Policy Article. You can also consider
- Does the item require a modifier?
- Does the item require a specific diagnosis?
- Did you receive a development letter?
If you disagree with the decision, consider submitting a redetermination request.
Published: 12.30.22
Reviewed: 03.28.24
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- Can a prior authorization decision be transferred to another supplier?
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Yes. The prior authorization decision and Unique Tracking Number (UTN) stays with the beneficiary. A supplier may transfer the UTN to another supplier per applicable privacy laws. Click here for more information about the prior authorization process.
Published: 03.21.24
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- Can the Standard Written Order (SWO) list multiple types of CPAP and RAD supplies and accessories such as masks, cushions, pillows, tubing?
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Yes. It is acceptable to use a generic description of each type of item ordered. For example, CPAP mask to fit, CPAP mask interface, CPAP tubing. It is also acceptable to list all potential CPAP/RAD supplies on the SWO. However, it is not acceptable to only write “CPAP Supplies” on the SWO. You must list each item that will be separately billed.
Published: 04.15.24
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Question & Answers (Q&As):
Medical Review Q&As
Selected MR Q&As:
- Assistive Technology Professional (ATP) Documentation for Wheelchairs Requiring In-Person ATP Involvement
- Complex Rehab Repair
- External Infusion Pump Policy – Parenteral Inotropic Therapy
- Final Rule CMS-1713-F – Standard Written Orders
- Medical Review - General
- Oxygen
- Positive Airway Pressure (PAP) – Practitioner
- Positive Airway Pressure (PAP) – Supplier
- Power Mobility Devices – Medical Review
- Power Mobility Devices – Rentals
- Refill Requirements for Non-consumable Supplies
myCGS Web Portal Q&As
Answers to questions about all aspects of registration, recertification, passwords, and using myCGS.
Provider Outreach and Education (POE) Q&As
Selected Q&As based on topic or policy, compiled through our interactions with our Jurisdiction B and Jurisdiction C supplier community:
- Ankle Foot Orthosis (AFO) & Knee Ankle Foot Orthosis (KAFO) Webinar
- Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFs) Elimination
- Competitive Bidding Program (CBP) Modifiers
- Continuous Glucose Monitors (CGMs)
- Disasters & Public Health Emergencies (PHE)
- Documentation Requirements: Principles of Documentation Webinar
- Post COVID-19 Public Health Emergency (PHE)
- Spinal Orthoses Webinar
- Surgical Dressings Webinar
- Therapeutic Shoes for Persons with Diabetes
- Upper Limb Orthotics
- Written Order Prior to Delivery (WOPD) & Face-to-Face Encounter
Revised: 04.15.24