Claim Status & Remittance Advice/Payment Information
Claim status may be obtained by using any of the following options:
- myCGS Web Portal
- Claim Status Inquiry (CSI) using a gateway connection with a Network Service Vendor
- Software Vendor, Billing Service or Clearinghouse
- Interactive Voice Response (IVR) (Telephone)
myCGS Online Portal
The Claim Status screen in myCGS allows you to find the status of any claim you have submitted to Jurisdiction B or C (depending on which jurisdiction you have selected). Within the Claim Status screen, you can find detailed information about your individual claims, including claim denial explanations, as well as perform specific tasks associated with the claim including:
- Claim Correction – request a simple correction to the claim
- Redeterminations – submit a Redetermination request form for the claim
- Reopenings – submit a Reopening request form for the claim
- Order RA – order a duplicate Remittance Advice
- ADR – check to see if an ADR letter was sent regarding the claim
For more information visit the myCGS Web Portal page. To get started, refer to the myCGS Registration and Account Management Guide for detailed instructions on how to register. Once you've successfully registered, the myCGS User Manual is your guide to successfully learning and using myCGS. Also be sure to check out our myCGS FAQs for answers to common questions.
Claim Status Inquiry (CSI)
Claim Status Inquiry (CSI) allows you to electronically check the status of production claims after they have passed the front-end edits and received a Claim Control Number (CCN).
A gateway connection with a Network Service Vendor must first be established. CGS has agreements with the following Network Service Vendor:
The service provider will provide downloading instructions, a login ID, and a password to access the gateway via a dial-up phone number (modem) or an IP address to use via FTP (file transfer protocol).
Once you have successfully signed up with a Network Service Vendor, please complete the CSI User ID Access Request Form to receive a user ID and password. This form can be faxed to 615.782.4626 or mailed to CGS, ATTN: VPIQ, PO Box 20010, Nashville, TN 37202. It is important to note that you will need two user IDs and passwords to access the CSI system – one from the Network Service Vendor and one from CGS.
For more details regarding Claim Status, please see the Claim Status Inquiry User Guide.
Claim Status Inquiry (CSI) Annual Recertification
CGS implemented an annual recertification process that requires users to complete the CSI Recertification Form every year. This new process started in April 2023. If you have not submitted a CSI Recertification Form
since April, you must complete a new form by July 31, 2023. If you do not submit the recertification form prior to July 31st, 2023, your access will be deactivated, and you will need to re-register to continue access to the CSI application.
Please make sure to complete all fields to ensure there are no issues.
If you currently have access in both Jurisdiction B and Jurisdiction C, you will only need to send one form. Please be sure to include all NPI/PTANs that you need to continue to have access to.
Software Vendor, Billing Service or Clearinghouse
The Common Electronic Data Interchange (CEDI) Contractor publishes an Approved Entities List on their web site. Please refer to the CEDI Enrollment information on the NGS CEDI website and find information about other electronic transactions
Electronic Remittance Advice/Claim Payment Information
Claim payment information is available electronically the same day your claim is finalized.
If you would like to start receiving electronic remittance advice (ERA) instead of receiving the paper explanation of benefits, follow the below steps:
- Verify you are capable of receiving the 835 transaction file. If you are a self-biller, verify this information with your software vendor. If you are using a 3rd party biller, verify the information with your billing service/ clearinghouse. You will need a Network Service Vendor (NSV) to receive the ERA from CEDI.
- Complete the CEDI Guided Enrollment Process
to enroll in CEDI or to add Health Care Payment/Advice (835 v5010A1) to an existing enrollment.
- You will receive an e-mail confirmation once request has been completed. You will begin to see the electronic remit files immediately. If your software vendor, billing service, or clearinghouse is able to receive the electronic remittance advise 835 file but does not have a program to translate it into a readable format, the Centers for Medicare & Medicaid Services does offer a free software called free Medicare Remit Easy Print (MREP) Software
.
Related Information
- 5010 277CA Reject Code Lookup Tool
- CEDI Enrollment Information
- Claim Payment Alerts
- Claim Status Inquiry User Guide
- Claim Submission and Denials Online Tools and Calculators
- CSI User ID Access Request Form
- CSI User ID Recertification Form
- Electronic Funds Transfer (EFT) Authorization Form
- Interactive Voice Response (IVR) (Telephone)
- Medicare Beneficiary Identifier (MBI)
- myCGS Forms/Checklists/Guides
- Remittance Advice Instructions Tool
Updated on June 15, 2023