Part B - Ohio
CGS Administrators, LLC provides a variety of services for Medicare beneficiaries,
health care providers, and medical equipment suppliers in 33 states supporting
the needs of over 16 million Medicare beneficiaries nationwide.
As a Medicare Part A, Part B, Home Health and Hospice, and Durable Medical
Equipment contractor for the Centers for Medicare & Medicaid Services,
we process and pay Medicare claims according to the Congressional Laws and
CMS rules and regulations. We do not determine who is eligible for Medicare.
CGS Administrators, LLC currently provides Part A Medicare claims processing and customer support
services in the states of: Kentucky and Ohio. CGS also provides services
for Home Health and Hospice in the states of Colorado, Delaware, DC, Iowa,
Kansas, Maryland, Missouri, Montana, Nebraska, N Dakota, S Dakota, Pennsylvania,
Utah, Virginia, West Virginia, and Wyoming. In addition we provide services
for Medicare Part B for the states of: Ohio and Kentucky, and we provide
service to Durable Medical Equipment suppliers in the states of: Alabama,
Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico,
North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas,
U.S. Virgin Islands, Virginia, and West Virginia.
This section has important information about filing claims to the A/B MAC.
Most Medicare providers are required to bill claims electronically (rather
than paper) in accordance with the Administrative Simplification Compliance
- General Claims Resources
How to submit Part B claims. Here you'll find claims resources, help with
common claim submission errors, the IVR system, and more!
- Comprehensive Error Rate Testing
The Centers for Medicare & Medicaid Services (CMS) developed the Comprehensive
Error Rate Testing (CERT) program to produce national, contractor-specific,
and service-specific paid claim error rates. Find CERT information and
- Electronic Data Interchange (EDI)
Looking for EDI information? Learn about MREP, crossover claims, how to
get started billing electronically, and much more.
The Centers for Medicare & Medicaid Services (CMS) website provides a dedicated ICD-10 web page which offers a variety of resources to assist providers with the ICD-10 implementation. Here are just some of the resources available on the CMS ICD-10 website.
- Top 5 Denials and Resolutions
Often within claims processing, we notice trends and patterns among the
filed claims regarding denials from provider services. The five listed
are consistently at the top of the list. These files will give further
information about the denial, as well as the easiest way to resolve those
- Five Levels in the Appeals Process
Take a detailed look at redeterminations, requesting a reconsideration, Administrative Law Judge hearings, Appeals Council review, and Judicial Review in U.S. District Court.
- Primary Care Incentive Program (PCIP)
For primary care services furnished on or after January 1, 2011 and before
January 1, 2016, a 10 percent incentive payment will be provided to primary
care practitioners. CMS has provided CGS Administrators, LLC with a list
of the National Provider Identifiers (NPIs) of the primary care practitioners
eligible to receive the incentive payments. Use this tool to find out if
you are eligible to participate in the Primary Care Incentive Program.
Medicare Timely Filing Guidelines
CMS-1500/ Electronic Claim Crosswalk
Electronic Data Interchange (EDI)
Ohio Part B Coverage & Pricing
- Medical Review
What is Medical Review? What are the types of contractors we work with
to achieve the goal of reducing improper payments?
- Medical Director Contact
Mailing and telephone information for your Ohio Part B Medical
- Fee Schedules
The Part B Physician Fee Schedule, Physician Fee Schedule Relative Value
Units, ZIP Code Files, and more.
- Local Coverage Determinations
Review active LCDs and Policy Articles, as well as draft articles and
the LCD Reconsideration Process.
- Self-Administered Drugs
Process to Determine Which Drugs Are Not Usually Self-Administered by
the Patient and SAD List
Ohio Part B Events & Education
- ACT (Ask the Contractor Teleconferences)
This is your opportunity to ask questions regarding Medicare issues that
impact your company and receive answers from Part B subject matter experts.
- Online Education Center
Don't have time to attend a workshop or sit in on a Webinar? Our Online
Education Center allows you to choose from a variety of courses and to
explore them at your own pace.
- Video Education
Our video education modules provide targeted information on a variety
of Medicare topics. CGS is committed to providing the most current and
relevant educational material for our Fee for Service Providers (FFS).
- Ohio Education Page
This section includes the Calendar of Events, and Workshop and Webinar
Listings for Ohio.
- Educational Materials and Job Aids
Our Provider Outreach and Education department creates educational materials for our Part B Providers. These materals are on a broad range of subject matter that will be beneficial to your office.
Our primary source of educational materials comes from the Medicare Learning
For comprehensive educational materials and tools, visit the Medicare Learning
Network (MLN). These materials have been designed to promote the CMS goal of
providing Up-to-date educational information to Medicare providers that accompany
the release of new or revised Medicare program policies.
As a result of changes in policy and legislation, Medicare providers may be
uncertain as to what Medicare policy changes have occurred and how those changes
apply to them. The MLN provides a variety of training and educational materials
that break down Medicare policy into plain language. The MLN delivers planned
and coordinated provider education through the various mechanisms such as National
Educational Articles, Brochures, Fact Sheets, Web-Based Training Courses, Videos
Ohio Part B Provider Enrollment
Provider/Supplier enrollment is a critical function that attempts to ensure
that only qualified and eligible individuals and entities are enrolled in the
Medicare Program and receive reimbursement for services furnished to beneficiaries.
Provider Enrollment Quick Links
- CMS FAQs
By selecting this option you will be taken to the CMS website.
- Part B FAQs
Choose from a variety of topics, including Coordination of Benefits, Electronic
Data Interchange, Medicare Secondary Payer, and more. You'll also find
a complete listing of past FAQs on a variety of topics, including Overpayment
Recovery, Medical Review and more.
Part B Forms
Welcome to the Part B forms section. As forms are identified and updated for
Part B, we will post them to this section.
The forms offered below are in Adobe PDF format. Download
a free copy of Acrobat Reader.
General Part B
Extended Repayment Plan (ERP)
Electronic Data Interchange
All EDI forms and correspondence must be submitted
to the address and/or fax number below for processing. This includes forms for new
setups as well as forms for changes to existing setups. Failure to send the
forms to the correct address will result in the application being returned
|J15 — Part B Correspondence
CGS Administrators, LLC
PO Box 20018
Nashville, TN 37202
|FAX: 615.664.5927 (preferred method for all EDI Correspondance)
Ohio Part B News & Publications
Important and timely articles and information for the current month.
The Part B Physician Fee Schedule, Ambulatory Surgical Center Fee Schedule
database, Physician Fee Schedule Relative Value Units, ZIP Code Files,
The Medicare Bulletin contains important information that will assist
the provider community in day to day operations. It includes information
published during the previous quarter by the Centers of Medicare and Medicaid
Services (CMS) and by CGS
- Medicare Incentives Program Job Aid
The Medicare Incentives Job Aid is a document that breaks down the various incentives CMS offers as part of the Medicare Program. Included are PQRS, HPSA, Primary Care Incentive, and more!
- Medicare Resources
An overview or the Medicare Program, including the Medicare Appeals Process,
Provider Enrollment, Web Tools, and more.
- Medicare Advisory
The Medicare Advisory was a periodical produced by Palmetto GBA.
For your convenience, we have made the last few years of this publication
- Specialty Manuals
The specialty-specific coverage and billing guidelines are available
through these PDF files. Any changes, additions, or modifications to these
manuals will be posted to the CGS Web site and in the Medicare Bulletin.
- EDI Connection
The EDI Connection has been developed especially for software vendors.
The EDI Connection, together with occasional special releases, serves
as legal notice to vendors concerning the responsibilities and requirements
imposed upon them by Medicare law, regulations and guidelines.