Corporate
CGS Administrators, LLC

Serving the states of AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX, VA, WV and the U.S. territories Puerto Rico and the Virgin Islands

Submitting a Claim

Getting Started

Before submitting claims, you must enroll in the Medicare program. This section provides you with information on getting started

Completing the Claim Form

Preparing a claim for Medicare can be complicated. Review this section to learn more about the claim preparation process and explore the tools available to assist you.

Documentation

Medicare requires you to have proper documentation to support payment of your claim. Review this section for information on documentation requirements

Submitting Your Claim

Most Medicare claims must be filed electronically and within specific time frames. This section provides you with information on electronic options available for you. You will also learn about paper claim filing limitations.

Medicare Beneficiary Identifier (MBI)

Claims may be submitted with either an MBI or HICN during the transition period. The transition period ends on December 31, 2019.

Claim Preparation Tools

To help make your claim preparation and submission process a little easier, we have developed a variety of tools and calculators just for you.

Advance Beneficiary Notices (ABNS)

An Advance Beneficiary Notice (ABN) is a written notice that suppliers may give to a Medicare beneficiary before providing items and/or services that Medicare otherwise might pay for, but for this particular occasion is expected to deny.

Advanced Modifier Engine - New!

The Advanced Modifier Engine was designed by CGS to assist suppliers in billing proper Healthcare Common Procedure Coding Systems (HCPCS) codes and modifier combinations. The tool includes Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) commonly billed HCPCS with billing scenarios. Based on the specific HCPCS entered and the billing scenario, the tool recommends modifiers for claim submission.

Helpful Forms

We have developed a wide variety of forms to help you with everything from pre-claim documentation requirements to requesting a review of your claims payments.

The PWK Segment

When submitting claims to the DME MAC, you have the option of mailing or faxing hard copy documentation to accompany your electronically-submitted DMEPOS claims. This is accomplished through the use of what is called the PWK (paperwork) segment.

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