CGS Listens! Announcing Process Improvements
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March 30, 2017 - Revised: 03.31.17

CGS Listens! Announcing Process Improvements

Your voice was heard and appreciated. We made improvements within the past year in response to your comments in the Medicare Satisfaction Indicator (MSI) Survey feedback results. Based on supplier feedback, CGS enhanced Customer Service, Provider Enrollment, Medical Review, Audit & Reimbursement, Provider Outreach and Education, myCGS Web Portal and the CGS website.

myCGS Web Portal:

CGS implemented enhanced Reopenings forms based on process improvements that allow Part B Providers to initiate adjustments via the new portal form.

Medical Review (MR):

Granular denial result letters are being sent via ELMS in order to give providers more clarity

Written communication has been developed to provide links to CGS and CMS resources that are applicable to the providers' specific educational needs.

Verbal one on one education consists of providing education tools and resources to use in submission of appropriate documentation as well as providing examples as guides for future claims.

MR currently has one educator consultant Home Health and Hospice and is actively seeking additional consultants for the other two lines of business.

Provider Outreach and Education (POE):

Implemented data driven education based on common inquiries received from high volume callers to the Provider Contact Center.

Increasing the online education courses and conducting more education based on Hot Topics from the Provider Contact Center and Provider Feedback.

Provider Contact Center (PCC):

CGS deployed updates based on feedback from the MSI survey to increase resource information for advocates.

CGS enhanced Customer Service Representatives training to ensure comprehensive policy knowledge and consistency in responses to provider inquiries.


Cross-trained staff on high volume reason codes to prevent claims processing delays.

Increased collaborations between Part A/HHH Claims and PCSP departments to review any claim issues for resolution

Hiring additional Claims Processor

Provided Up Trained Claims Processors on high volume reason codes

Increased our Analyze on high volume aged claims

Provider Enrollment:

Provider Enrollment staff participate in monthly PCC staff training sessions to share the latest updates on enrollment topics, review current revalidation trends and updates and share PECOS tips to increase overall awareness and effectiveness to assist callers with their questions

Working with staff to review and ensure voice messages and responses are being completed timely

Implemented an interactive application help tool on the CGS Provider Enrollment website – this self-help tool allows providers/suppliers to answer a series of questions related to their respective enrollment scenario and the tool will tell them which application to submit, which sections are required to be filled out and what required documentation is needed for a complete and accurate submission which leads to shorter processing times


Currently working to redesign the layout of the J15 Websites to be consistent across Lines of Business and to increase ease of use by providers.

Audit & Reimbursement:

Improved communication with providers by discussing controversial and/or material adjustments prior to sending the Pending Settlement Letter.

Increased supervisor or mentor involvement with the providers during the review process.

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