Are you ready for Account Linking? Step-by-step instructions available under the 'My Account' tab.
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What is myCGS?myCGS is a FREE, web-based, secure provider self-service application developed specifically to serve the needs of health care providers and their staff throughout our Jurisdiction 15. CGS's goal is to give providers secure, fast access to their Medicare information seamlessly via the myCGS portal. The myCGS application provides the following types of information:
Terms and Conditions The Terms and Conditions provide privacy and security notices consistent with applicable federal laws, directives, and other federal guidance for accessing this Government system, which includes:
This system is provided for Government-authorized use only. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. Personal use of social media and networking sites on this system is limited as to not interfere with official work duties and is subject to monitoring. By using this system, you understand and consent to the terms. To view the terms in its entirety, go to the myCGS Log-In page
HIPAA Eligibility Transaction System (HETS) Inquiries Rules of Behavior The Centers for Medicare & Medicaid Services (CMS) is committed to maintaining the integrity and security of health care data in accordance with applicable laws and regulations. The HETS Rules of Behavior reiterates your responsibility in obtaining, disseminating, and using beneficiaries’ Medicare eligibility data. It further explains the expectations for using HETS. You must accept these HETS Rules of Behavior in order to gain access to the system.
Why Use myCGS?myCGS is THE solution to moving toward a totally automated office, focusing on efficiency and convenience. The top reasons we reject claims is due to beneficiary eligibility issues. Using myCGS to query your patient's status will save you TONS of time and money by submitting claims to the correct payer the first time! myCGS offers a wide range of information and features to make your Medicare lives a whole lot easier! Most functions are available to you 24 hours a day, seven days a week! And – it's completely FREE!
myCGS AvailabilitymyCGS will generally be available 24 hours a day, seven days a week. However, access to myCGS does not guarantee that all functions will be available. Refer to the availability times below for times when each function is available. myCGS scheduled maintenance times are also listed below.
If scheduled myCGS maintenance is required, it will be performed during the times listed below:
Our goal is to avoid any service interruptions during normal operating hours. However, unscheduled maintenance may be necessary in order to immediately address systems security threats or performance issues. When you access myCGS and it is not available, you should see a page that indicates maintenance is in progress. Also, refer to the myCGS Status Page for updates known issues.
System RequirementsTo optimize usability of myCGS, we recommend that users verify their system adheres to the following requirements: Operating System:
Supported Internet Browsers:
Recommended Screen Resolution: 1024x 768 Additional Requirements:
NOTE: Although myCGS may still be accessible without meeting these requirements, only the options above are supported. Failure to meet these requirements may adversely affect the functionality and layout of myCGS. Compatibility Settings If you are using Internet Explorer 8.0, please make sure you have selected the compatibility settings to help make myCGS work better.
SupportFor questions or assistance with myCGS, contact the EDI Help Desk, available 7:00 a.m. – 4:30 p.m. CST (8:00 a.m. – 5:30 p.m. EST) EDI Help Desk
Within myCGS, there are "Help" buttons on each screen, which link you to the myCGS User Manual with more information about myCGS. Did You Know?To further assist, we offer the “Did You Know? Page, which is a dedicated set of Q&As specific to the navigation and function of myCGS.
Registering for myCGSIn order to register and use myCGS a provider (each PTAN/NPI combination) must have a signed Electronic Data Interchange (EDI) Enrollment Agreement on file with CGS. A link to the EDI Enrollment Agreement is located on page one of the EDI Enrollment Packet. If you do not already have an EDI Enrollment Agreement on file with CGS, please complete one before attempting to register for myCGS. Registration Process
NOTE: If you try to log into myCGS before you have accessed the validation link, you will see the profile screen where you can update or correct your e-mail address, if needed. If your e-mail address is correct, you may click on the link to request a new e-mail. Verify that your e-mail address is correct on your profile before calling the EDI Help Desk for assistance. If you are sure your e-mail address is correct, but you do not receive your e-mail, your company's e-mail security settings may need to be updated to allow incoming e-mails from myCGS. Unsuccessful RegistrationIf you entered registration information incorrectly, myCGS will display an error message in RED at the top of the screen. (Remember, you must have an EDI Enrollment Agreement on file with us to successfully register.) Carefully review the error message and correct the information. If you have verified the information entered is correct and you are still unable to register, contact the EDI Help Desk for assistance. User ID AssignmentOnce you have successfully registered, you will be assigned a Provider Administrator User ID. (Refer to the Roles section.) In some cases, a User ID will begin with what appears to be the letter 'O'. Please note this is the number zero (0). Using the letter 'O' instead of the number '0' will not allow you access to myCGS. You will then be asked to choose your password and answer your security questions. (Refer to the User ID Passwords and User ID Security Questions sections). Once the Provider Administrator has established his/her security, the Provider Administrator can create User IDs for additional staff to access myCGS.
RolesmyCGS users are assigned one of two roles: A Provider Administrator or a Provider User. Provider AdministratorThe first person who registers a provider's PTAN/NPI combination is considered the Provider Administrator. Provider Administrators will have access to all tabs and functions within myCGS. This person is responsible for maintaining the portal for the PTAN/NPI combination, which includes registering, granting permissions, and deleting users. NOTE: We suggest there be at least two Provider Administrators established for each provider office. This is especially important in the event a Provider Administrator is unable to log into myCGS on a regular basis or leaves the practice. If this happens and no one is assigned the role as an additional Provider Administrator, all established Provider Users may risk being deleted. Provider UserProvider Users are established by the Provider Administrator, and are granted rights to some/all tabs within myCGS. Those tabs for which Provider Users have not been granted access will be grayed out, and will not be accessible. If you need access to tabs which are grayed, you must seek access from your Provider Administrator. (CGS does not determine access or security for Provider Users.) There is no limit to the number of Provider Users that can be established under the Provider Administrator.
Logging Into myCGSIf you were assigned a password by your Provider Administrator and this is the first time you are logging in, you will be prompted to agree to the "Terms of Use," change your password, and choose your security questions and answers. (See the User ID Passwords and User ID Security Questions sections.) Once you have received your User ID, created your password, and selected and answered your security questions, you can access myCGS at https://www.cgsmedicare.com/myCGS/index.html. Click on the "Log In" link.
Enter your User ID and password in the appropriate fields and click "Log In."
CGS recommends that all Provider Administrators and all Provider Users sign into myCGS at least once every two weeks. For more information, refer to the User ID Disabled section. Multi-Factor Authentication (MFA)MFA is a CMS requirement that provides an additional form of security to safeguard provider and patient information. The MFA verification code is an eight-digit code that must be entered before gaining access to myCGS. During the registration process, you were required to identify how you want myCGS to send the MFA code, either by text, email, or the Google Authenticator mobile app.
Once you receive the verification code, enter it in the appropriate field and click "Submit." If you need a new code, you may click Regenerate Code to select an option (text, email, or Google Authenticator) to enter a new one.
The verification code you receive via text or email may be used repeatedly for up to 12 hours from the generation time of the code. If you log out of myCGS and, within 12 hours of the generation of the original MFA code, log back in, you will be directed to the "Welcome to myCGS" screen, where you may simply re-enter your original MFA verification code. In the event your MFA verification code expires or cannot be located, you can always generate a new verification code that can be used for up to 12 hours by clicking the "Regenerate Code" link. If using Google Authenticator, the 6-digit code changes every 30 seconds. Be sure to use the code that coincides with your myCGS account for which you are accessing.
myCGS Session TimeoutFor security purposes, all myCGS sessions will automatically timeout after 15 minutes of inactivity. A notification box will display when you are approaching your inactivity limit. If you wish to continue your session, click 'Stay and Continue" and your session will be extended.
If you are automatically logged out, you may log back in without delay.
User ID DisabledCMS and CGS are dedicated to keeping your information safe. To achieve this, access to myCGS must be limited to users who use the system on a regular basis. As a result, a User ID will be disabled when it has not been used in 30 days. For this reason, CGS recommends that all Provider Administrators and all Provider Users sign into myCGS at least once every two weeks.
CGS encourages more than one Provider Administrator. 30-Day Lock-Out Notification TimerSo that all users know when their accounts are in jeopardy of being terminated due to inactivity of the Provider Administrator, myCGS will display a timer to notify you of this. The initial notification timer will display on day 30. The notification timer appears daily starting at day 15 through day 1. When you see this notification, immediately to alert your Provider Administrator to log into myCGS to avoid terminating the entire account.
Logging Out of myCGSWhen you are done using myCGS, you must log out to end your session. To log out, click on the 'Logout' link, which is located in the upper right of any screen in myCGS.
For your security, if you do not log out, myCGS will automatically timeout after 15 minutes of inactivity. You may log back in at any time.
Claim StatusTo access claim information:
Claims that are paid, in process, returned or denied are displayed. Information is retrieved from CMS standard systems and is as current as the standard systems. Claims that are offline or returned without processing will not appear. Detailed Claims Status InformationThe header of the "Detailed Claim Status Information" page provides information specific to the claim. You will also see a letter icon in the "ADR Letter" field if the claim is pending response to a request for additional documentation. Also, the "Diagnosis" field will display the primary diagnosis submitted on the claim.
The line item details are noted directly below the header information, which includes:
The Detailed Claim Status Information page for Part B users will not display the co-insurance information in the header, but on each detail line instead.
Depending upon the status of the claim, the date of service and/or the date the claim was processed, you may perform a number of functions directly from the status page:
For your convenience, when you select one of the functions noted above, you will be routed to the applicable online form. Most of the required fields on the form will auto-populate with information from the claim and specific to your User ID. NOTE: Options above that are not available for the claim displayed will be grayed out. Grayed options could also indicate you do not have authorization to perform that function. Check with your Provider Administrator for access. You may also click "Back" to return to the claim list.
Detailed Claims Status InformationThe header of the "Detailed Claim Status Information" page provides information specific to the claim. You will also see a letter icon in the "ADR Letter" field if the claim is pending response to a request for additional documentation. Also, the "Diagnosis" field will display the primary diagnosis submitted on the claim.
The line item details are noted directly below the header information, which includes:
The Detailed Claim Status Information page for Part B users will not display the co-insurance information in the header, but on each detail line instead.
Depending upon the status of the claim, the date of service and/or the date the claim was processed, you may perform a number of functions directly from the status page:
For your convenience, when you select one of the functions noted above, you will be routed to the applicable online form. Most of the required fields on the form will auto-populate with information from the claim and specific to your User ID. NOTE: Options above that are not available for the claim displayed will be grayed out. Grayed options could also indicate you do not have authorization to perform that function. Check with your Provider Administrator for access. You may also click "Back" to return to the claim list.
Part A Claims Practice AddressesPart A Outpatient Prospective Payment System (OPPS) hospital providers can confirm that the practice addresses submitted on claims are an exact match to the Provider Enrollment, Chain, and Ownership System (PECOS) to help avoid/correct any Return to Provider (RTP) claims. This function is provided to ensure compliance with Change Requests (CRs) 9613 and 9907 as noted in MLN Matters® article SE19007. Once this process is implemented, CMS will direct A/B MACs to permanently turn on two system edits to enforce the requirements in the CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 1, section 170:
To access the practice addresses associated with your Part A account:
A list of addresses associated with your NPI and PTAN will display as they appear in PECOS. Ensure the service location address reported on your claim is an exact match. NOTE:The practice addresses information is updated on a weekly basis. Please allow up to 10 business days after you receive confirmation for a new/revised practice location address to become available in myCGS.
Part B Claims SubmissionPart B users have access to the electronic claim submission feature by selecting the "Claim Submission" sub-tab. If the "Claim Submission" sub-tab is not displaying, the user is either not registered as or using a Part B account or may not have access to this feature. Check with your Provider Administrator for assistance. As you enter data, this intuitive form will display the specific fields needed to submit your electronic claim according to ANSI 5010 requirements. Be sure to have all information needed to complete an electronic claim or the CMS-1500 claim form readily available. Refer to the CMS-1500 Claim Form/ANSI 5010 Crosswalk
Patient Information Section
Insured Information SectionOnly when "Medigap/Crossover Claim" is selected at the very top of the claim will the "Insured Information" section display. Complete this section with details of the other plan.
Miscellaneous Claim Information Section
Diagnosis Information SectionAt least one (primary) ICD-10 diagnosis code must be entered. Up to 12 diagnoses may be submitted on the claim. Line Items Section
NOTE: The "Total Charges" field is auto-populated based on the claim lines added to the form. Specialty/Service Type Line ItemsThe claim will display all applicable fields depending upon the CPT/HCPCS code and/or place of service entered. Ambulance
Chiropractic
Screening Mammography
Erythropoietin (EPO)
Drug NOC
Podiatry
AttachmentsYou may attach files to your claims up to 40MB each. The combined size of all attachments cannot exceed 150MB. The attachments must be in PDF format and created using appropriate PDF creation software. Failure to create the PDF correctly can result in a corrupt file that could prevent you from successfully submitting the claim through myCGS.
Claim Submission SummaryOnce you successfully submit the claim, myCGS will direct you to a "Claim Submission Summary" page that will provide the Transaction ID for this submission. The Transaction ID will serve as a confirmation number for the submission until the claim is accepted into our processing system.
Confirmation MessagesYou will receive messages regarding claims submitted through myCGS in your inbox under the "Messages" tab. The first message is the submission confirmation. This message confirms that the form was sent. A second message will be available once the claim submission is accepted or rejected. This may take 24-48 hours (not including weekends or holidays) to receive. If the submission is accepted, an ICN or DCN (if attachments are submitted) will be provided in the message. (Refer to the Messages section of the user manual for more information.) NOTE: Receiving an accepted message does not mean that the claim was approved to be paid. Once the claim is processed, the approval or denial information will be noted on the "Detailed Claim Status Information" page or on your remittance advice. Rejected ClaimsElectronic claims must pass front-end edits prior to entering our processing system. myCGS claims are subject to this same editing. Claims submitted through myCGS that fail these edits are rejected. You may access the rejected claim, make the necessary corrections, and release it to be processed.
NOTE: The CGS Advance Communication Engine (ACE) Smart Edits are also a part of the pre-adjudication process. Medicare Secondary Payer (MSP) Claim
If "Secondary" is selected at the top of the claim, the form will display a "Patient Relationship to Insured" field and "Insured Information" section located further down.
Under "Miscellaneous Claim Information," additional fields will display. Be sure to identify the Insurance Type Code.
NOTE: Refer to the "Eligibility"tab under the "MSP"sub-tab to locate the Insurance Type.
NOTE: The primary insurance EOB is NOT required. Include any attachments needed to support allowing the service(s) submitted.
Patient Information Section
Insured Information SectionOnly when “Medigap/Crossover Claim”is selected at the very top of the claim will the “Insured Information”section display. Complete this section with details of the other plan.
Miscellaneous Claim Information Section
Diagnosis Information SectionAt least one (primary) ICD-10 diagnosis code must be entered. Up to 12 diagnoses may be submitted on the claim.
Line Items Section
NOTE: The “Total Charges” field is auto-populated based on the claim lines added to the form.
Specialty/Service Type Line ItemsThe claim will display all applicable fields depending upon the CPT/HCPCS code and/or place of service entered. Ambulance
Chiropractic
Screening Mammography
Erythropoietin (EPO)
Drug NOC
Podiatry
AttachmentsYou may attach files to your claims up to 40MB each. The combined size of all attachments cannot exceed 150MB. The attachments must be in PDF format and created using appropriate PDF creation software. Failure to create the PDF correctly can result in a corrupt file that could prevent you from successfully submitting the claim through myCGS.
Claim Submission SummaryOnce you successfully submit the claim, myCGS will direct you to a “Claim Submission Summary” page that will provide the Transaction ID for this submission. The Transaction ID will serve as a confirmation number for the submission until the claim is accepted into our processing system.
Confirmation MessagesYou will receive messages regarding claims submitted through myCGS in your inbox under the "Messages" tab. The first message is the submission confirmation. This message confirms that the form was sent. A second message will be available once the claim submission is accepted or rejected. This may take 24-48 hours (not including weekends or holidays) to receive. If the submission is accepted, an ICN or DCN (if attachments are submitted) will be provided in the message. (Refer to the Messages section of the user manual for more information.) NOTE: Receiving an accepted message does not mean that the claim was approved to be paid. Once the claim is processed, the approval or denial information will be noted on the "Detailed Claim Status Information" page or on your remittance advice.
Rejected ClaimsElectronic claims must pass front-end edits prior to entering our processing system. myCGS claims are subject to this same editing. Claims submitted through myCGS that fail these edits are rejected. You may access the rejected claim, make the necessary corrections, and release it to be processed.
Medicare Secondary Payer (MSP) Claim
If "Secondary" is selected at the top of the claim, the form will display a "Patient Relationship to Insured" field and "Insured Information" section located further down.
Under "Miscellaneous Claim Information," additional fields will display. Be sure to identify the Insurance Type Code.
NOTE: Refer to the "Eligibility"tab under the "MSP"sub-tab to locate the Insurance Type.
NOTE: The primary insurance EOB is NOT required. Include any attachments needed to support allowing the service(s) submitted.
View an ADRTo view the details of an ADR, click on the claim number.
After selecting a claim number, the "Detailed Claim Status Information" page is displayed. Here you will find details specific to the ADR and claim, including:
Ask a General QuestionIf you have a general question regarding the ADR, you may select the "Ask a Question" button. Doing this will display an inquiry form pre-populated with details of the claim and ADR. Complete the remaining fields, attach any documentation you would like to send, and submit the form.
NOTE: As indicated at the top of the form, do not submit documentation in response to an ADR. This form is for general inquiries only.
Respond to Pending ADRsAs an added convenience, you may respond to claims with a pending ADR status directly from your MR Dashboard.
NOTE: If you click on the claim number instead, the "MR Detail Claim Status" page will include an option to "Submit Documents," which will also allow you to access the auto-populated MR ADR Response Form.
Additional OptionsDepending upon the status of the ADR, you may be able to perform additional functions:
No ADRsIf you find no ADRs on your MR Dashboard, a message will display to let you know.
Post-Pay ReviewYour MR Dashboard also allows you access to claims reviewed on a post-pay basis. To view, select the Post Pay Review Cases sub-tab.
Also, like the Medical Review Claims sub-tab, depending upon the status of the post-pay review, you will be able to complete other functions including asking questions and requesting a Redetermination or a Part B Reopening. When one of these options is selected, that form will open and auto-populate with information specific to the provider, claim, and the patient. Refer to sections above for additional information on other functions.
Remittance Look-UpTo access your remittances:
NOTE: Remittances are readily available for approximately one year. If you need to retrieve remittances that are older than one year, myCGS may experience a delay. CGS does not guarantee access to remittances that are older than one year Once you have chosen the search option for remittances you want to view, click "Submit."
Sorting and Viewing RemittancesRemittances that fall within your search option will display on the "Lookup Results" page. The remittance with the most recent date will appear at the top of the list.
Printing RemittancesOnce your remittance is displayed, you can print a copy by clicking on the "Print" icon located on the menu bar of the program used to view PDFs (e.g., Acrobat Reader, Microsoft Edge, etc.)
NOTE: If you do not have Acrobat Reader software, you can download it at no cost. You also may be able to view PDFs in your Internet browser. To enter new search criteria, click the "New Lookup" button.
InquiryUse the “Inquiry” sub-tab to enter beneficiary information to submit an eligibility request. To ensure accurate information is provided to you, all fields entered, including optional fields, must be an exact match to the data maintained in CMS’ HETS. The following combination of fields are required:
The optional fields are not required to receive a valid Medicare beneficiary eligibility benefit response. If data is entered into an optional field, however, and the information does not match the beneficiary's data maintained in CMS’ HETS, eligibility data will not be returned on the eligibility response tabs. The optional fields are as follows:
Click “Submit Inquiry” to obtain eligibility information. Once retrieved, all the other sub-tabs will populate with data related to that beneficiary, if applicable.
EligibilityThe "Eligibility" sub-tab provides information regarding the beneficiary's Medicare coverage. If information does not populate, for example, either the "Part A Eligibility" or "Part B Eligibility" benefit information, it means the beneficiary is not eligible to receive Medicare benefits for the requested period on the inquiry screen.
The following tables provide information for the "Eligibility" sub-tab fields: Part A Eligibility Benefit Information
Part B Eligibility Benefit Information
Inactive Periods
Beneficiary Address
End Stage Renal Disease (ESRD) Information
NOTE: The ESRD section displays only active ESRD data and will not be available if no notification has been received by CMS indicating an ESRD period is active and in effect per the date(s) requested. MBI End Date Medicare Diabetes Prevention Program (MDPP)
Deductibles/CapsThe “Deductibles/Caps” sub-tab provides information regarding the beneficiary’s Part B deductibles, co-insurance, occupational/physical/speech therapy caps, and other services.
The following tables provide information for the “Deductible/Caps” sub-tab fields: Part B Deductible
Part B Remaining Deductible
Co-insurance Details
Blood Deductible
Occupational Therapy Cap
Physical and Speech Therapy Cap
Pulmonary Rehabilitation Services
Cardiac Rehabilitation Services
Intensive Cardiac Rehabilitation Services
Part B Free Services
Mental Health Co-insurance
PreventiveThe "Preventive" sub-tab provides information regarding preventive services the beneficiary has received. Specific CPT/HCPCS codes and the dates the beneficiary is next eligible to receive services are listed as appropriate. NOTE: Only HCPCS codes for which a beneficiary is eligible will be displayed and grouped together under their appropriate categories. If a service has been rendered, it is removed from the list until closer to the time the beneficiary is eligible to receive the service again.
The following tables provide information for the "Preventive" sub-tab fields: COVID-19 Immunization myCGS will display the most recent information for the COVID-19 vaccine and its administration.
Smoking Cessation Information
Pneumococcal Vaccine (PPV) Accupuncture Effective for claims with dates of service (DOS) on and after January 21, 2020, Medicare will cover acupuncture for chronic Low Back Pain (cLBP)
Deductible Remaining by Spell
Plan CoverageThe “Plan Coverage” sub-tab provides information regarding the beneficiary’s enrollment under Medicare Advantage (MA) Managed Care Plans (commonly referred to as Part C contracts) that provide Part A and B benefits for beneficiaries. This sub-tab also provides information on a beneficiary’s Part D prescription drug coverage. NOTE: Whenever myCGS indicates that a beneficiary has coverage through a non-Medicare entity (MA or Medicare Drug Benefit plans), the inquiring provider should always contact the non-Medicare entity for complete beneficiary entitlement information.
The table below describes the “Plan Coverage” sub-tab fields:
When a beneficiary has a primary payer other than Medicare, the “Medicare Secondary Payer (MSP)” tab provides the beneficiary’s primary insurance information.
MSPThe “MSP” sub-tab is populated if the beneficiary has a payer that processes claims primary to Medicare. This sub-tab displays only active MSP data and will not be listed if there is no MSP data or if notification of coverage primary to Medicare has not been received by CMS. NOTE: If a date range is entered on the “Inquiry” screen, it will affect the MSP data returned.
The table below describes the “MSP” sub-tab fields:
Hospice/Home HealthThe Home Health Care section provides information for each episode start and end date and the corresponding billing activity dates. The Hospice section provides eligibility information when the hospice benefit is effective and when it terminates, in addition to the total hospice occurrence count for the listed beneficiary. If the patient has any gap in their episode of care or changes providers at any time, or if their hospice provider has sent the final claim revoking hospice care, you will see more than just a single effective date being returned. Once the final claim has been submitted, the hospice termination (or revocation) date is returned, along with the revocation code. If the patient is still in hospice care, but has changed providers, the start and termination date with each provider will be returned. Therefore, if no termination date is returned, it is to be assumed that the patient is still under hospice care, as no claim has yet been processed that revokes that period of care. NOTE: The "Hospice/Home Health" sub-tab displays hospice and/or home health data and will not be accessible when there have been no claims received by CMS indicating hospice or home health coverage is active and is in effect per the date(s) requested. To make sure you see all the information, enter a date range in the inquiry screen.
The tables below describe the "Home Health/Hospice" sub-tab fields: Home Health Care
Hospice
myCGS will display up to 50 billed Hospice episodes that occurred in the last four years.
InpatientThe “Inpatient” sub-tab includes Inpatient, Skilled Nursing Facility (SNF), and Psychiatric Benefit Data sections. The Inpatient section provides hospital inpatient benefit and billing information. The SNF section provides SNF benefit and billing information. NOTE: While the Psychiatric Benefit Data section now displays in myCGS, the data is not yet available in CMS’ HIPAA Eligibility Transaction System (HETS) 270/271 system that we are required to access for eligibility. The system will return hospital inpatient default deductibles based on the requested start year when the following occurs:
In addition, the system will continue to return the hospital inpatient default deductible remaining amounts, inpatient co-payment days, and SNF co-payment days based on the beneficiary’s Part A entitlement start year when the following occurs:
NOTE: Depending on the date(s) range requested, multiple inpatient and SNF spells might be displayed. The data returned on this screen is directly impacted by timely submission of claims by the provider. The data returned is compiled from claims that have been processed by the Common Working File (CWF). To make sure you see all the information, enter a date range in the inquiry screen. If a single hospital inpatient/SNF spell spans more than one calendar year, myCGS will return the daily co-payment amounts associated with the beginning year of the spell.
The table below describes the “Inpatient” sub-tab fields: Part A Deductible
Part A Base Deductible Remaining
Deductible Remaining by Spell
Inpatient Spell Dates
Inpatient Base Summary
Inpatient Days Remaining
SNF Base Summary
SNF Days Remaining
Lifetime Reserve Days
Lifetime Psychiatric Benefit Data
Part A Free Services
QMBBeneficiaries who are enrolled in the Qualified Medicare Beneficiary (QMB) program are dually eligible for both Medicare and Medicaid. Those enrolled in this State Medicaid benefit, which assists low-income Medicare beneficiaries with Medicare Part A and Part B premiums and cost-sharing (deductibles, co-insurance/co-pays), are not liable financially. QMB status may fluctuate for a minority of beneficiaries. If eligibility results indicate the beneficiary QMB enrollment has terminated, please verify the patient's QMB status through online State Medicaid eligibility systems or other documentation, including Medicaid identification cards and documents issued by the state proving the patient qualifies for the QMB program. The “QMB” sub-tab includes Medicaid Enrollment, Part A Deductible, Inpatient, Skilled Nursing Facility (SNF), Part B Deductible, and Part B Co-Insurance sections. NOTE: "$0" will display in the deductible, co-insurance, and co-pay sections for beneficiaries enrolled in the QMB program.
What Is the Medicare Beneficiary Identifier?As a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the social security number-based Health Insurance Claim Number (HICN) was removed from the Medicare card and replaced with the new Medicare Beneficiary Identifier (MBI). All Medicare beneficiaries were mailed new Medicare cards identifying their newly assigned, system-generated MBIs. Beginning January 1, 2020, the MBI is used in all Medicare transactions in place of the HICN.
Using the MBI Look-Up ToolIf you need to obtain a patient's MBI:
Cash Flow SnapshotTo access your financial information:
Payment Floor StatusMedicare contractors are required to hold payments for a minimum predetermined number of days. The payment floor for electronic claims is 14 days, 29 days for paper claims. This section refers to all claims approved for payment waiting to be released from the payment floor as of the current date.
NOTE: The number and total dollar amount of claims on the payment floor could change daily. Claims will continue to be added to the payment floor as they are approved; some will be paid from the payment floor once they reach day 14.
Last 3 ChecksYou will find a list of the last three checks issued to the billing provider. The dates and amounts of the checks are identified here.
Financial FormsOn the “Financial Forms”sub-tab, Part A and Home Health Agencies (HHAs) can submit CMS-838 Credit Balance reports. Available to all providers is the Immediate Offset (eOffset) request form.
CMS-838 Credit BalancePart A and Home Health Agencies are required to submit quarterly Credit Balance reports within 30 days after the close of each calendar quarter. myCGS may be used to submit the actual CMS-838 form NOTE: A Medicare Credit Balance is an amount determined to be refundable to the Medicare program for an improper or excess payment made to a provider because of patient billing or claims processing errors.
Attachments You may attach files to your submission by selecting the “Browse” button. Each file may be up to 40MB. The combined size of all attachments cannot exceed 150MB. The attachments must be in PDF format and created using appropriate PDF creation software. Failure to create the PDF correctly can result in a corrupt file that could prevent you from successfully submitting the claim through myCGS. NOTE: CMS regulations prevent CGS from accepting electronic signatures; therefore, the first attachment must be the signed CMS-838 Credit Balance form.
Signature/Contact Enter the name and title of the person authorized to submit the report. The contact information may be pre-populated based upon your User ID. If the form and attachments are accurate, check the box to certify. Click “Submit” to send the form.
Confirmation Messages You will receive messages regarding your submission through myCGS in your inbox under the “Messages” tab. The first message is the submission confirmation. This message confirms that the form was sent. A second message will be available once the form is accepted. It will include instructions on how you can use the submission ID assigned to the case to check the status.
Immediate Offset (eOffset)myCGS allows you to submit an electronic authorization allowing us to offset funds to satisfy a pending overpayment due using an electronic eOffset Request Form. This authorization may be submitted each time a demanded overpayment is received, or you may authorize a permanent request for all future demanded overpayments. You may also monitor the status of the requests submitted through myCGS.
Once you select an option, a disclaimer box will display to confirm timeframes and to ensure you have selected the correct form.
Provider Level OffsetAfter accepting the disclaimer, the Provider Level Offset form will display. Most fields will show be pre-populated with information based on your provider and User ID. You must complete the remaining fields.
After completing the required fields, click “Submit”to send the request for automatic offset for future overpayments. An e-signature box will appear, asking you to verify that the information entered is correct. This ensures thesignature requirement for all requests have been met. Click “OK” if you agree or “Cancel”to return to the form to make changes/corrections.
After submitting the form, you will be taken to the “Messages”tab. Shortly after submission, you will receive a confirmation message acknowledging receipt of the eOffset request. A separate message will be sent to your inbox that will include a submission ID assigned to your request. This ID may be used to check the status of your submission. Demand Level OffsetWhen selecting the option for a one-time immediate offset, a window will display, allowing you to submit your request based on either the offset letter you received from CGS or up to 10 Accounts Receivable (AR) numbers identified on an attachment to the demand letter.
Selecting the “Letter” option allows you to enter the number located in the upper-right header area of the demand letter to request the immediate offset.
Selecting the “AR” option allows you to request a one-time immediate offset using the accounts receivable (AR) number assigned to the request.
Stop Provider Level Offset Previously RequestedThis form is to be used when you’ve previously submitted the Provider Level Offset form to authorize the immediate offset of all future demands but would now like to cancel that request. When you select this option, a message will display, informing you of critical time periods associated with your request. If you agree, click “OK.”
Message InboxYou may access the messages sent to you/your PTAN/NPI by either selecting the “Messages” tab located in the menu or clicking Retrieve Messages displayed in the Message Bar. The Retrieve Messages link is accessible from all tabs.
Both options will take you directly to your Message Inbox.
Inbox FoldersmyCGS defaults to display all messages delivered to your inbox. Each message is also sorted to its corresponding folder, allowing you quick access to view a specific type of message. The folders available are:
To find a specific type of letter sent to your PTAN/NPI, go to the appropriate folder. For example, to find a letter sent to your PTAN/NPI requesting additional documentation to complete processing of a submitted claim, go to the ADR folder. There you will find all messages that include the additional documentation/development requests sent to the PTAN/NPI.
NOTE: Messages will be automatically moved to the ARCHIVED MESSAGES sub-tab after 60 days. Messages will NOT be available after 365 days.
Inbox FilteringInbox Filtering is available to allow you to search your inbox for a specific message or letter. You may filter your inbox by:
*Green Mail letters may be filtered only by date, submission ID, and E-Letters options. Messages may be filtered by ALL options.
Select your filtering option, enter the criteria, then click the “Filter” button.
NOTE: Confirmation messages for Claim Inquiries you submit are not available when you filter by MBI or Claim Number; however, the confirmations can be found in the Claim Inquires inbox folder.
Viewing MessagesYour inbox will default to a date sort so that all messages are in order by date of receipt. You may change the sort by clicking on the column headers for subject or submission ID.
Your inbox also includes pagination, allowing you to change the number of messages viewed on a page (located at top), and quickly move through multiple pages (located at bottom).
To view a message, click on the link in the “Subject”column. A window will open, providing instructions and a link to the actual correspondence. Click on the link to view.
To save a step, you also have the option to download a PDF copy of the letter directly from your messages Inbox. Click on the download icon located in the “Submission ID” column.
Either way, a PDF copy of the correspondence mailed to you will display.
NOTE: Messages delivered to your inbox that include correspondence specific to a particular workload will also be mailed to you hardcopy if your organization has not opted in for Green Mail. Messages received as a result of forms submitted to us for processing will have a subject, “Form Received,” to advise you that your submission has been received. It will not display a submission ID until one has been assigned by CGS. Once CGS has assigned the submission ID, you will receive another message with a link, “Secure Form Confirmation,” under the “Subject” column. Click on this link to view the message. The message identifies the unique identifier assigned to your request (e.g., Appeal DCN) and includes instructions on how to use the identifier to track the status of your request.
Archiving MessagesTo maintain your inbox, you have the option of archiving messages. To archive a message or multiple messages, check the box of the message and click the “Archived Selected” button. NOTE: Messages will be automatically moved to the ARCHIVED MESSAGES sub-tab after 60 days.
A message will display asking you to confirm. Click “OK” to archive the message.
To access archived inbox messages, select the “Archived Messages” sub-tab.
NOTE: You may use the Inbox Folders and filtering options to locate archived messages. Messages delivered to your inbox that include correspondence specific to a particular workload will also be mailed to you hardcopy if your organization has not opted in for Green Mail.
Deleting MessagesYou also have the option of deleting messages from either your inbox or under the “Archive” tab. To delete a message or multiple messages, check the box of the message and click the “Delete Selected” button.
A message will display asking you to confirm. Click “OK” to delete the message. Deleted message may not be recovered.
NOTE: Messages will NOT be available after 365 days.
Accessing MessagesYou may access the messages sent to you/your PTAN/NPI by either selecting the “Messages” tab located in the menu or clicking the link displayed in the Message Bar. Both options will take you directly to your Message Inbox, where you may view all messages. NOTE: Messages delivered to your inbox will also be mailed to you hardcopy if your organization has not OPTED IN for GreenMail. Your inbox will default to a date sort so that all messages are in order by date of receipt. You may change the sort by clicking on the column headers for subject, unique identifier, or submission ID. To view a message, click on the link in the “Subject”column.
The correspondence will appear just like the what you are used to receiving in the mail. Messages received as a result of forms submitted to us for processing will have a subject, “Form Received,” to advise you that your submission has been received. It will not display a submission ID until one has been assigned by CGS. Once CGS has assigned the submission ID, you will receive another message with a link, “Secure Form Confirmation,” under the “Subject” column. Click on this link to view the message. The message identifies the unique identifier assigned to your request (e.g., Appeal DCN) and includes instructions on how to use the identifier to track the status of your request.
Archiving MessagesTo maintain your inbox, you have the option of archiving messages. To archive a message, click on the paper icon located in the last column of the message (“Archive” column). Once the icon is selected, the message is archived. To access archived inbox messages, select the “Archived Messages” sub-tab.
Deleting MessagesYou also have the option of deleting messages from either your inbox or under the “Archive” tab. To delete a message, click on the box in the “Action” column of the line to be deleted. Click the “Delete Selected” button. To delete more than one message at a time, click on the box in the header. Doing this will check all lines. You may uncheck the lines of any you do not want to delete. Once you have checked all lines you want to delete, click on the “Delete Selected” button.
Forms Available in myCGSThe forms available in myCGS may vary based on your line of business (i.e., Part A, Part B, Home Health, Hospice). They include the following:
* Form is located under the "Financial Tools"tab ** Form is located under the "Claims"tab
Accessing myCGS FormsSelect the "Forms"tab to access the "Secure Forms"page.
You may also access the "Secure Forms"page by selecting the "Go To Page"drop-down box. This is also a way to access the "Financial Forms"sub-tab.
Once on the "Secure Forms" page, you will find an option to "Select a Topic." Options in the drop-down box include Redeterminations, Reopenings (for Part B), Audit & Reimbursement (for Part A and HHH), Medical Review, and Provider Contact Center.
NOTE: Provider Administrators have access to all tabs within myCGS. Provider Users have access to only the tabs the Provider Administrator has granted permission to access. If you have access to the forms available in myCGS, the ‘Forms,’ ‘Financial Tools’ and ‘Claims’ tabs will be visible once you successfully log into the portal. If a tab is grayed out, but you believe you need access to the tab, contact your Provider Administrator.
RedeterminationsProviders and beneficiaries may appeal an initial claim determination when Medicare's decision is to deny or partially deny a claim. The first level of the appeal process is a redetermination. You have 120 days from the date of receipt of the notice of initial determination to submit a request. There is no monetary threshold. For instructions, please refer to the job aid for your line of business: HHH, Part A, Part B
Reopenings (Part B)Part B Reopenings may be accepted to correct minor errors and omissions on previously processed claims. Requests must be submitted within 12 months of the original claim remittance date. Separate job aids are available to make corrections to dates of service, place of service, modifiers, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) codes, billed amounts, and more.
Audit & ReimbursementPart A and HHH providers are required to submit financial data that support amounts claimed in a cost report directly to CGS. This financial information is reviewed and processed by our Audit & Reimbursement team. This sensitive information and other correspondence may be submitted securely through myCGS. Instructions are available to help with navigation: myCGS Enhancement: Audit & Reimbursement (A&R) Secure Messaging Part A providers are required to submit financial data, which supports amounts claimed in a cost report, directly to CGS. This financial information is reviewed and processed by our Audit & Reimbursement (A&R) team. NOTE: Per the Centers for Medicare & Medicaid Services (CMS), cost report submissions are no longer accepted through myCGS, or this enhancement. Please refer to MLN Matters® article MM10611 To submit information using this enhancement: Step 1: Once you are logged into myCGS, select the FORMS tab. Step 2: From the 'Select a Topic' drop-down menu, click the 'Audit and Reimbursement' option. Step 3: From the 'Select a Type' drop-down menu, click the 'A & R Correspondence Part A' option. Step 4: Click on the 'A & R Correspondence link to view the form.
Once the form loads, you will find some information pre-populated with identifying information for your PTAN/NPI. Step 5: From the 'Fiscal Year End Date' field, select the date from the calendar icon or enter the fiscal year end date in the XX/XX/XXXX format.
Step 6: Enter the name of the specific CGS employee for whom the correspondence is being sent. Step 7: In the 'Workload' field, click the drop-down box to select the subject of your correspondence. The options available are:
NOTE: Please refer to MLN Matters® article MM10611
Attach the documents you want to include with your submission. You may attach up to 10 documents. Each attachment must be in one of the following formats and can be up to 40 MBs in size. The total size of all attachments cannot exceed 150 MBs. NOTE: At least ONE attachment must be submitted. Document format types accepted through Secure Message:
Step 8: Click the 'Browse' button. A window will open allowing you to locate the document stored on your system. Once you locate the document click "OPEN" to attach it to the form. A status bar (in BLUE) will appear indicating the document is uploading.
All files attached will appear under "Attached Files." If a file is attached in error, simply click the RED 'X' in the 'Action' column to remove it. Once the form is complete, enter your name and hit SUBMIT to send the form and its attachments. Once received, confirmation will be delivered to your secure inbox letting you know. Responses sent to you by our A&R team will also be delivered to your inbox.
Comparative Billing ReportsComparative Billing Reports (CBRs) are created to give you a snapshot of your specific billing pattern data in comparison to peer groups within your CGS jurisdiction. This information is helpful in conducting education and self-audit activity. Details on requesting this data is available for your line of business: HHH, Part A, Part B Home Health Agencies (HHAs) also have access to Request for Anticipated Payment (RAP) CBRs. The RAP CBRs will allow HHAs to monitor the percentage of RAP ratios.
Responding to Requests for Additional DocumentationThe myCGS web portal allows you to respond to our additional documentation request (ADR) letters directly from your MR Dashboard and Claims tab. MR Dashboard:
You can also access the form if you are on the 'Detailed Claim Status Information' page by clicking the 'Submit Documentation' button.
For your convenience, the MR ADR form will auto-populate with information in most of the required fields. Claims Tab:
To save you time, the form will auto-populate with information in most of the required fields. When claims are pending due to an ADR, do not use the 'Ask a Question' button, as it will not route the documentation you attached to the pending claim.
Reconsiderations (HHH and Part A)Home Health, Hospice, and Part A providers may request a reconsideration(a second-level appeal) through myCGS. The request must be submitted within 180 days from the date of receipt of the redetermination decision. In cases where the redetermination request is dismissed, a reconsideration may be requested within 60 days of the dismissal notice. The form is available under the “Claims”tab for claims that have completed the first-level appeal, redetermination. HHH, Part A
General InquiriesYou may submit general questions through myCGS related to various topics, including appeals, finance, education, and medical review. The form is available for each line of business: HHH, Part A, Part B
Immediate OffsetAn immediate offset is your electronic authorization allowing us to offset funds to satisfy an overpayment requested by CGS. You may request an immediate offset each time a demanded overpayment is received or authorize a permanent request for all future demanded overpayments. The forms are located under the “Financial Forms”sub-tab. Instructions on completing the forms are available in the myCGS Financial User Manual NOTE: Provider Administrators have access to all tabs within myCGS. Provider Users have access to only the tabs the Provider Administrator has granted them permission to access. If you have access to the forms available in myCGS, the “Forms,” “Financial Tools,” and “Claims” tabs will be visible once you successfully log into the portal. If a tab is grayed out but you believe you need access to the tab, contact your Provider Administrator.
Credit BalanceA Medicare credit balance is an amount determined to be refundable to the Medicare program for an improper or excess payment made to a provider because of patient billing or claims processing errors. Each HHH and Part A provider must submit a quarterly Credit Balance Report (Form CMS-838). To ensure timely receipt and processing, myCGS is the preferred method of submission. The form is located under the “Financial Forms”sub-tab. Instructions to help with completion are available to you: HHH, Part A
Overpayment Recovery Request (Part B)Part B providers may submit an Overpayment Recovery Request to notify us of an overpayment. Doing this will generate a demand letter identifying the amount to be refunded. Once the request is received, approved, and processed, we will issue an overpayment demand letter. The debtor has 30 days from the date of the demand letter to submit the refund. (See Immediate Offset to avoid delays and possible interest added to the principle balance.) Once you are logged into myCGS, select the FORMS tab.
Completing a FormYou will find the form you select is pre-populated with information specific to your account, including the provider name, PTAN, and NPI. Complete the remaining fields of the form. Those fields that are required are marked with a red asterisk (*). Attachments SectionMost of the forms in myCGS give you the option to attach additional documentation (e.g., medical records, operative/radiology reports, attestations) you would like CGS to consider when processing your request. You may attach up to 10 documents. Each document must be in a PDF format and can be up to 40MB. The total size of all attachments cannot exceed 150MB. To add an attachment, select the “Browse” button, and a window will open, allowing you to locate the PDF document you wish to add. Select the PDF document to attach it. Repeat this process for each additional PDF document you wish to attach.
Attachments SectionMost of the forms in myCGS give you the option to attach additional documentation (e.g., medical records, operative/radiology reports, attestations) you would like CGS to consider when processing your request. You may attach up to 10 documents. Each document must be in a PDF format and can be up to 40MB. The total size of all attachments cannot exceed 150MB. To add an attachment, select the “Browse” button, and a window will open, allowing you to locate the PDF document you wish to add. Select the PDF document to attach it. Repeat this process for each additional PDF document you wish to attach.
Submitting a FormOnce all required information has been entered, and all necessary PDF documents have been attached, click “Submit.” An e-signature box will appear, asking you to verify that the information entered and documents attached are correct. This ensures thesignature requirement for all forms have been met. If the information was entered correctly, and all desired attachments were included, click “OK” to submit the form and all attachments.
If any information needs to be corrected, or if any attachments need to be added or deleted, click “Cancel” to return to the form.
The "Admin" TabOnly Provider Administrators have access to the “Admin” tab, which is in the header of myCGS.
The screen defaults to the Provider User Listing. This page lists all admins and users registered under your PTAN/NPI.
Unlocking AccountsAll myCGS users (Provider Administrators and Provider Users) are required to log into myCGS at least once every 30 days. Inactivity results in the ID being disabled. (If the inactivity continues, the ID will eventually be terminated.) Users will receive an e-mail informing them if their account is disabled.
Also, myCGS IDs will be locked upon three unsuccessful login attempts within a 120-minute time span. Provider Administrators are responsible for unlocking accounts disabled for these reasons. To unlock an account:
Account RecertificationTo ensure all myCGS users are compliant with updated Centers for Medicare & Medicaid Services (CMS) security requirements, account recertification will be required to be completed by the Provider Administrator. This task must be completed every 360 days. Notification pop-up messages will display upon login within 47 days of the date recertification is due.
Failure to complete the process timely will result in an interruption of service, including deactivation. The user cannot access myCGS until the recertification is completed. This process applies to the Provider Administrator as well.
To recertify an account:
NOTE: These steps would apply if the Provider Administrator is recertifying his/her own access to myCGS.
Adding New UsersWhen adding new Provider Administrators and Provider Users to your account, each user must have a unique User ID and password. The User ID must be created with the user’s actual first and last name. Generic first and last names are not permitted. User IDs and passwords should never be shared. Examples of unacceptable user names:
To add a new user:
Modifying User AccountsIf a user’s role has changed and you need to allow or remove permissions for performing certain myCGS functions, as Provider Administrator, you may modify user accounts. To edit an account:
Deleting a UserThe Provider Administrator is responsible for managing myCGS access for the entire office/organization. This includes deleting users who no longer need access to the portal.
Green MailmyCGS allows Provider Administrators to select the Green Mail option, which is a function that allows myCGS users IMMEDIATE access to correspondence sent from CGS. This includes:
Notification is delivered to the myCGS “Messages” tab of users registered under a specific PTAN/NPI combination. To ensure you receive the notification, users are also sent an e-mail to the registered e-mail address, informing them that notification has been delivered to the myCGS inbox. Options for Green Mail are:
Account InformationAfter clicking on the tab, myCGS defaults to the “Account Information”sub-tab, which identifies the name(s) of your Provider Administrator(s) along with a link to contact him/her via email. You will also find your account information, which includes your name, validation questions and answers, business address, and Multi-factor Authentication (MFA) Set-up section.
Validation Questions & AnswersDuring the registration process, you were prompted to select six questions and provide answers to those questions. The purpose of the questions is to validate your identity should you forget your password and need to reset and enter a new one. Under the "Account Information" sub-tab, you may change the questions you selected originally and provide new answers.
NOTE: There are a total of six validation questions, so be sure to complete all six question and answer fields.
Contact InformationYour contact information associated with the account is also available under the "Account Information" sub-tab. This information was added during the registration process. You may change your contact information as needed.
Multi-Factor Authentication (MFA)CMS requires us to implement an additional level of security when accessing myCGS due to the amount of sensitive information accessible through the web portal. The MFA process meets that requirement, as users are required to enter an eight-digit code before gaining access to myCGS. During the registration process, you identified whether you wanted to receive your MFA code via e-mail, text, or both. This option can be changed under the "Account Information" sub-tab. If you want to add the text option, complete the "Mobile Phone" and "Carrier" fields located at the bottom of the page.
Google Authenticator (GA)Instead of receiving your MFA code via text or email, you may use the Google Authenticator (GA) app. The app is available for download on your desktop computer/laptop or mobile devices. For mobile devices (i.e., cell phones, tablets) you may download the app from the App Store (Apple) and Android Play Store (Android). To install GA onto your desktop computer/laptop:
For instant access, we suggest you pin the GA icon to the toolbar.
Log into myCGS, go to the “My Account” tab, and complete the steps based on the browser you use. To install the Google Authenticator mobile app and link it to myCGS:
TIPS
Confirm/Verify ChangesWhen changes (such as those noted above) are made to the "Account Information" sub-tab, you must save your changes.
Change PasswordmyCGS requires that you change your password at least once every 30 days. You will receive reminders as the date nears. If your password is compromised, you are encouraged to change your password immediately instead of waiting for the 30-day notification. To change your password:
Profile VerificationTo meet CMS security guidelines, all users must verify that the information on his/her profile is accurate and current. This process is required every 250 days. myCGS tracks this timeframe to ensure this task is completed. NOTE: If you have multiple accounts and IDs and selected one as your Super ID (see Account Linking above), Profile Verification is performed on just the Super ID and not the accounts linked to the Super ID.
Account LinkingmyCGS requires users to maintain separate User IDs for each PTAN/NPI combination. If you manage multiple accounts, you have multiple User IDs. Account Linking allows you to combine multiple User IDs under one Super ID. From your new Super ID, you can select one of your linked accounts to perform functions available under that PTAN/NPI. NOTE: User IDs linked to your selected Super ID must be active. If, for example, the User ID has been terminated due to inactivity, was not recertified by your Provider Administrator, did not receive timely profile verification, or was terminated by your Provider Administrator, it cannot be linked to your Super ID. To link an account:
Account Linking Tips!
Under the "Medical Review" tab of myCGS, you have access to your MR Dashboard, allowing you to quickly identify MR ADRs sent to you. As an added convenience, you can perform several functions directly from your MR Dashboard, including:
Select the "Medical Review" tab to access your MR Dashboard.
ADR letters sent from our MR department will be listed by the claim number (Internal Control Number (ICN) or Document Control Number (DCN)) assigned to the actual claim. You may sort the list of claims by clicking the header to change the sort.
View an ADRTo view the details of an ADR, click on the claim number.
After selecting a claim number, the "Detailed Claim Status Information" page is displayed. Here you will find details specific to the ADR and claim, including:
Ask a General QuestionIf you have a general question regarding the ADR, you may select the "Ask a Question" button. Doing this will display an inquiry form pre-populated with details of the claim and ADR. Complete the remaining fields, attach any documentation you would like to send, and submit the form.
NOTE: As indicated at the top of the form, do not submit documentation in response to an ADR. This form is for general inquiries only. Respond to Pending ADRsAs an added convenience, you may respond to claims with a pending ADR status directly from your MR Dashboard.
NOTE: If you click on the claim number instead, the "MR Detail Claim Status" page will include an option to "Submit Documents," which will also allow you to access the auto-populated MR ADR Response Form. Additional OptionsDepending upon the status of the ADR, you may be able to perform additional functions:
No ADRsIf you find no ADRs on your MR Dashboard, a message will display to let you know.
Post-Pay ReviewYour MR Dashboard also allows you access to claims reviewed on a post-pay basis. To view, select the Post Pay Review Cases sub-tab.
Also, like the Medical Review Claims sub-tab, depending upon the status of the post-pay review, you will be able to complete other functions including asking questions and requesting a Redetermination or a Part B Reopening. When one of these options is selected, that form will open and auto-populate with information specific to the provider, claim, and the patient. Refer to sections above for additional information on other functions. “Eligibility” TabTo access beneficiary eligibility information, click on the “Eligibility” tab. Once selected, myCGS defaults to the “Inquiry” sub-tab.
If you need technical assistance with myCGS, please contact the EDI Help Desk:
Refer to the availability times below for times when each function is available.
If scheduled myCGS maintenance is required, it will be performed during the times listed below:
Our goal is to avoid any service interruptions during normal operating hours. However, unscheduled maintenance may be necessary in order to immediately address systems security threats or performance issues. When you access myCGS and it is not available, you should see a page that indicates maintenance is in progress. Also, refer to the myCGS Status Page for reported issues and updates.
Prior Authorization (PA) for Certain Hospital Outpatient Department (OPD) Services (Part A)CMS implemented a prior authorization process for certain services provided in the outpatient department of the hospital. This process requires OPDs to submit requests for provisional affirmation of coverage to be reviewed BEFORE the applicable services is furnished. PA requests may be submitted through myCGS and is available to users registered as Part A providers. NOTE: This is a Part A requirement. Users registered under Part B do not have access to this form. Instructions to help with completion of the PA form are available: Part A
RedeterminationsWhen you log into myCGS, you will find the FORMS tab. This option will allow you to access and submit CGS forms through myCGS. NOTE: Provider Administrators will have access to the tab by default. If the FORMS tab is grayed, please contact your Provider Administrator for access. Once logged in, select the Forms tab. Under the “Select a Topic” drop-down box, click “Redeterminations.” From the “Select a Type” drop-down box, click “Redeterminations.” Select the Redeterminations: 1st Level Appeal link located at the bottom of the screen.
You may also utilize the Appeals Calculator if you need help determining if your redetermination request is timely. By selecting the Appeals Calculator link, a new window will open. Enter the date of the initial determination of the service being appealed and click the Calculate! button.
The Appeals Calulator will display a date. The redetermination request must be received by the date displayed in order to be considered a timely request. If timely, return to the Redetermination screen to complete the form.
When completing the form, please note that fields with a RED* are required. This includes the beneficiary, provider and claim information. The specific service(s) being appealed must be added to the form by clicking the ADD button to populate the appropriate box. Also, identify whether the request is to appeal an overpayment. There is also an area to note the reason the redetermination request is being submitted. This field will hold up to 1200 characters.
Once the required fields are complete, select the VALIDATE button. myCGS will verify that all required fields are populated. When validated, a message will appear at the top of the screen inGREEN confirming this and the next steps prior to submitting the request. At least one attachment must be sent with the request. Examples of documentation needed to process the redetermination request includes medical records, operative/radiology reports,and other documentation to support the service(s) being appealed. You can attach up to five documents. Attachments can be up to 40MBs in size, not to exceed to total of 150MBs for allattachments. The documents must be in a PDF format. Click on the Browse button and a window will open allowing you to locate and attach the PDFdocument to the form.
Enter the name of the person requesting the redetermination in the NAME field. Click the Submit button when the form is complete and ready to be submitted.
An ‘e-signature’ box will appear, asking you to verify that the information entered and attachments are correct. This ensures the signature requirement for submitting a redetermination request has been met. If the information was entered correctly, and all desired attachments were included, click ‘OK’ to submit the form and all attachments. If corrections need to be made to the form or if any attachments need to be added or deleted, click ‘Cancel’ to return to the form. After submitting the form, you will be taken to the Message tab. Shortly after submission, you will receive a message confirming receipt of the Redetermination request. A separate messagewill be sent to your inbox, which will include a Submission ID assigned to your request. The Submission ID may be used to track the status of your request.
Please refer to the Messages tab of the myCGS User Manual for more details.
Checking Redetermination StatusAppeals status is displayed under the Claims tab in myCGS. To view the status of an appeal:
The Detailed Claim Status Information page identifying the claim information now displays an Appeals window. If a 1st level appeal, Redetermination, has been requested on the claim, you will see this window populate.
In the Appeals window, you will see:
If the Redetermination is in a "Closed" status and the decision is Unfavorable, Partially-Favorable, or a dismissal, you may view the letter sent to you explaining our decision by clicking on the "View Decision Letter" link.
The decision letter is a PDF of the letter you receive via Green Mail or hardcopy. NOTE: A Fully-Favorable decision will not generate a letter. Please refer to your Remittance Advice to find the adjustment.
Submitting a 2nd Level AppealUse myCGS to submit a request for Reconsideration, the 2nd level of the Appeal process. A new Appeals window allows user to track the 1st and 2nd level appeals requested on the claim. From the Claim Status Information page, click on the claim number to view the claim details.
The Detailed Claim Status Information page identifying the information submitted on the claim now displays an Appeals window. If a 1st level appeal, Redetermination, has been requested on the claim, you will see this window populated.
If the Redetermination is in a "Closed" status and the decision is Unfavorable, Partially-Favorable, or a dismissal, you may view the letter sent to you explaining our decision by clicking on the "View Decision Letter" link.
NOTE: A Fully-Favorable decision will not generate a letter. Please refer to your Remittance Advice to find the adjustment.
If you disagree with the decision of your Redetermination as noted in the decision letter, you may request a Reconsideration of the Qualified Independent Contractor (QIC). The QICs for our jurisdiction are C2C Innovative Solutions, Inc. (C2C) and Maximus. Your request for Reconsideration may be submitted through myCGS! This is done by selecting the Submit a 2nd Level Appeal button located in the lower-right corner of the Appeals window.
The Reconsiderations form will display pre-populated with the details of your claim and User ID.
Complete the required fields including the reason you are submitting the Reconsideration request and attach any supporting documentation to the form. Once the Reconsideration is requested, you will see its status in the Appeals window directly below the Redeterminations information.
You will also receive confirmation in your Messages inbox that the request has been received. A second inbox message will be sent once the case is uploaded into our system and a Submission ID has been assigned.
What is myCGS?myCGS is a FREE, web-based, secure provider self-service application developed specifically to serve the needs of health care providers and their staff throughout our Jurisdiction 15. CGS's goal is to give providers secure, fast access to their Medicare information seamlessly via the myCGS portal. The myCGS application provides the following types of information:
Terms and Conditions The Terms and Conditions provide privacy and security notices consistent with applicable federal laws, directives, and other federal guidance for accessing this Government system, which includes:
This system is provided for Government-authorized use only. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. Personal use of social media and networking sites on this system is limited as to not interfere with official work duties and is subject to monitoring. By using this system, you understand and consent to the terms. To view the terms in its entirety, go to the myCGS Log-In page
HIPAA Eligibility Transaction System (HETS) Inquiries Rules of Behavior The Centers for Medicare & Medicaid Services (CMS) is committed to maintaining the integrity and security of health care data in accordance with applicable laws and regulations. The HETS Rules of Behavior reiterates your responsibility in obtaining, disseminating, and using beneficiaries’ Medicare eligibility data. It further explains the expectations for using HETS. You must accept these HETS Rules of Behavior in order to gain access to the system. HETS Rules of Behavior are available here. Why Use myCGS?myCGS is THE solution to moving toward a totally automated office, focusing on efficiency and convenience. The top reasons we reject claims is due to beneficiary eligibility issues. Using myCGS to query your patient's status will save you TONS of time and money by submitting claims to the correct payer the first time! myCGS offers a wide range of information and features to make your Medicare lives a whole lot easier! Most functions are available to you 24 hours a day, seven days a week! And – it's completely FREE! myCGS AvailabilitymyCGS will generally be available 24 hours a day, seven days a week. However, access to myCGS does not guarantee that all functions will be available. Refer to the availability times below for times when each function is available. myCGS scheduled maintenance times are also listed below.
If scheduled myCGS maintenance is required, it will be performed during the times listed below:
Our goal is to avoid any service interruptions during normal operating hours. However, unscheduled maintenance may be necessary in order to immediately address systems security threats or performance issues. When you access myCGS and it is not available, you should see a page that indicates maintenance is in progress. Also, refer to the myCGS Status Page for updates known issues. System RequirementsTo optimize usability of myCGS, we recommend that users verify their system adheres to the following requirements: Operating System:
Supported Internet Browsers:
Recommended Screen Resolution: 1024x 768 Additional Requirements:
NOTE: Although myCGS may still be accessible without meeting these requirements, only the options above are supported. Failure to meet these requirements may adversely affect the functionality and layout of myCGS. Compatibility Settings If you are using Internet Explorer 8.0, please make sure you have selected the compatibility settings to help make myCGS work better.
SupportFor questions or assistance with myCGS, contact the EDI Help Desk, available 7:00 a.m. – 4:30 p.m. CST (8:00 a.m. – 5:30 p.m. EST) EDI Help Desk
Within myCGS, there are "Help" buttons on each screen, which link you to the myCGS User Manual with more information about myCGS. Did You Know?To further assist, we offer the “Did You Know? Page, which is a dedicated set of Q&As specific to the navigation and function of myCGS. Registering for myCGSIn order to register and use myCGS a provider (each PTAN/NPI combination) must have a signed Electronic Data Interchange (EDI) Enrollment Agreement on file with CGS. A link to the EDI Enrollment Agreement is located on page one of the EDI Enrollment Packet. If you do not already have an EDI Enrollment Agreement on file with CGS, please complete one before attempting to register for myCGS. Registration Process
NOTE: If you try to log into myCGS before you have accessed the validation link, you will see the profile screen where you can update or correct your e-mail address, if needed. If your e-mail address is correct, you may click on the link to request a new e-mail. Verify that your e-mail address is correct on your profile before calling the EDI Help Desk for assistance. If you are sure your e-mail address is correct, but you do not receive your e-mail, your company's e-mail security settings may need to be updated to allow incoming e-mails from myCGS. Unsuccessful RegistrationIf you entered registration information incorrectly, myCGS will display an error message in RED at the top of the screen. (Remember, you must have an EDI Enrollment Agreement on file with us to successfully register.) Carefully review the error message and correct the information. If you have verified the information entered is correct and you are still unable to register, contact the EDI Help Desk for assistance. User ID AssignmentOnce you have successfully registered, you will be assigned a Provider Administrator User ID. (Refer to the Roles section.) In some cases, a User ID will begin with what appears to be the letter 'O'. Please note this is the number zero (0). Using the letter 'O' instead of the number '0' will not allow you access to myCGS. You will then be asked to choose your password and answer your security questions. (Refer to the User ID Passwords and User ID Security Questions sections). Once the Provider Administrator has established his/her security, the Provider Administrator can create User IDs for additional staff to access myCGS. RolesmyCGS users are assigned one of two roles: A Provider Administrator or a Provider User. Provider AdministratorThe first person who registers a provider's PTAN/NPI combination is considered the Provider Administrator. Provider Administrators will have access to all tabs and functions within myCGS. This person is responsible for maintaining the portal for the PTAN/NPI combination, which includes registering, granting permissions, and deleting users. NOTE: We suggest there be at least two Provider Administrators established for each provider office. This is especially important in the event a Provider Administrator is unable to log into myCGS on a regular basis or leaves the practice. If this happens and no one is assigned the role as an additional Provider Administrator, all established Provider Users may risk being deleted. Provider UserProvider Users are established by the Provider Administrator, and are granted rights to some/all tabs within myCGS. Those tabs for which Provider Users have not been granted access will be grayed out, and will not be accessible. If you need access to tabs which are grayed, you must seek access from your Provider Administrator. (CGS does not determine access or security for Provider Users.) There is no limit to the number of Provider Users that can be established under the Provider Administrator. Logging Into myCGSIf you were assigned a password by your Provider Administrator and this is the first time you are logging in, you will be prompted to agree to the "Terms of Use," change your password, and choose your security questions and answers. (See the User ID Passwords and User ID Security Questions sections.) Once you have received your User ID, created your password, and selected and answered your security questions, you can access myCGS at https://www.cgsmedicare.com/myCGS/index.html. Click on the "Log In" link.
Enter your User ID and password in the appropriate fields and click "Log In."
CGS recommends that all Provider Administrators and all Provider Users sign into myCGS at least once every two weeks. For more information, refer to the User ID Disabled section. Multi-Factor Authentication (MFA)MFA is a CMS requirement that provides an additional form of security to safeguard provider and patient information. The MFA verification code is an eight-digit code that must be entered before gaining access to myCGS. During the registration process, you were required to identify how you want myCGS to send the MFA code, either by text, email, or the Google Authenticator mobile app.
Once you receive the verification code, enter it in the appropriate field and click "Submit." If you need a new code, you may click Regenerate Code to select an option (text, email, or Google Authenticator) to enter a new one.
The verification code you receive via text or email may be used repeatedly for up to 12 hours from the generation time of the code. If you log out of myCGS and, within 12 hours of the generation of the original MFA code, log back in, you will be directed to the "Welcome to myCGS" screen, where you may simply re-enter your original MFA verification code. In the event your MFA verification code expires or cannot be located, you can always generate a new verification code that can be used for up to 12 hours by clicking the "Regenerate Code" link. If using Google Authenticator, the 6-digit code changes every 30 seconds. Be sure to use the code that coincides with your myCGS account for which you are accessing. myCGS Session TimeoutFor security purposes, all myCGS sessions will automatically timeout after 15 minutes of inactivity. A notification box will display when you are approaching your inactivity limit. If you wish to continue your session, click 'Stay and Continue" and your session will be extended.
If you are automatically logged out, you may log back in without delay. User ID DisabledCMS and CGS are dedicated to keeping your information safe. To achieve this, access to myCGS must be limited to users who use the system on a regular basis. As a result, a User ID will be disabled when it has not been used in 30 days. For this reason, CGS recommends that all Provider Administrators and all Provider Users sign into myCGS at least once every two weeks.
CGS encourages more than one Provider Administrator. 30-Day Lock-Out Notification TimerSo that all users know when their accounts are in jeopardy of being terminated due to inactivity of the Provider Administrator, myCGS will display a timer to notify you of this. The initial notification timer will display on day 30. The notification timer appears daily starting at day 15 through day 1. When you see this notification, immediately to alert your Provider Administrator to log into myCGS to avoid terminating the entire account. Logging Out of myCGSWhen you are done using myCGS, you must log out to end your session. To log out, click on the 'Logout' link, which is located in the upper right of any screen in myCGS.
For your security, if you do not log out, myCGS will automatically timeout after 15 minutes of inactivity. You may log back in at any time.
From the "Claims" tab of myCGS, you will be able to perform the following:
Claim StatusTo access claim information:
Claims that are paid, in process, returned or denied are displayed. Information is retrieved from CMS standard systems and is as current as the standard systems. Claims that are offline or returned without processing will not appear. Detailed Claims Status InformationThe header of the "Detailed Claim Status Information" page provides information specific to the claim. You will also see a letter icon in the "ADR Letter" field if the claim is pending response to a request for additional documentation. Also, the "Diagnosis" field will display the primary diagnosis submitted on the claim.
The line item details are noted directly below the header information, which includes:
The Detailed Claim Status Information page for Part B users will not display the co-insurance information in the header, but on each detail line instead.
Depending upon the status of the claim, the date of service and/or the date the claim was processed, you may perform a number of functions directly from the status page:
For your convenience, when you select one of the functions noted above, you will be routed to the applicable online form. Most of the required fields on the form will auto-populate with information from the claim and specific to your User ID. NOTE: Options above that are not available for the claim displayed will be grayed out. Grayed options could also indicate you do not have authorization to perform that function. Check with your Provider Administrator for access. You may also click "Back" to return to the claim list. Part A Claims Practice AddressesPart A Outpatient Prospective Payment System (OPPS) hospital providers can confirm that the practice addresses submitted on claims are an exact match to the Provider Enrollment, Chain, and Ownership System (PECOS) to help avoid/correct any Return to Provider (RTP) claims. This function is provided to ensure compliance with Change Requests (CRs) 9613 and 9907 as noted in MLN Matters® article SE19007. Once this process is implemented, CMS will direct A/B MACs to permanently turn on two system edits to enforce the requirements in the CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 1, section 170:
To access the practice addresses associated with your Part A account:
A list of addresses associated with your NPI and PTAN will display as they appear in PECOS. Ensure the service location address reported on your claim is an exact match. NOTE:The practice addresses information is updated on a weekly basis. Please allow up to 10 business days after you receive confirmation for a new/revised practice location address to become available in myCGS. Part B Claims SubmissionPart B users have access to the electronic claim submission feature by selecting the "Claim Submission" sub-tab. If the "Claim Submission" sub-tab is not displaying, the user is either not registered as or using a Part B account or may not have access to this feature. Check with your Provider Administrator for assistance. As you enter data, this intuitive form will display the specific fields needed to submit your electronic claim according to ANSI 5010 requirements. Be sure to have all information needed to complete an electronic claim or the CMS-1500 claim form readily available. Refer to the CMS-1500 Claim Form/ANSI 5010 Crosswalk
Patient Information Section
Insured Information SectionOnly when "Medigap/Crossover Claim" is selected at the very top of the claim will the "Insured Information" section display. Complete this section with details of the other plan.
Miscellaneous Claim Information Section
Diagnosis Information SectionAt least one (primary) ICD-10 diagnosis code must be entered. Up to 12 diagnoses may be submitted on the claim. Line Items Section
NOTE: The "Total Charges" field is auto-populated based on the claim lines added to the form. Specialty/Service Type Line ItemsThe claim will display all applicable fields depending upon the CPT/HCPCS code and/or place of service entered. Ambulance
Chiropractic
Screening Mammography
Erythropoietin (EPO)
Drug NOC
Podiatry
AttachmentsYou may attach files to your claims up to 40MB each. The combined size of all attachments cannot exceed 150MB. The attachments must be in PDF format and created using appropriate PDF creation software. Failure to create the PDF correctly can result in a corrupt file that could prevent you from successfully submitting the claim through myCGS.
Claim Submission SummaryOnce you successfully submit the claim, myCGS will direct you to a "Claim Submission Summary" page that will provide the Transaction ID for this submission. The Transaction ID will serve as a confirmation number for the submission until the claim is accepted into our processing system.
Confirmation MessagesYou will receive messages regarding claims submitted through myCGS in your inbox under the "Messages" tab. The first message is the submission confirmation. This message confirms that the form was sent. A second message will be available once the claim submission is accepted or rejected. This may take 24-48 hours (not including weekends or holidays) to receive. If the submission is accepted, an ICN or DCN (if attachments are submitted) will be provided in the message. (Refer to the Messages section of the user manual for more information.) NOTE: Receiving an accepted message does not mean that the claim was approved to be paid. Once the claim is processed, the approval or denial information will be noted on the "Detailed Claim Status Information" page or on your remittance advice. Rejected ClaimsElectronic claims must pass front-end edits prior to entering our processing system. myCGS claims are subject to this same editing. Claims submitted through myCGS that fail these edits are rejected. You may access the rejected claim, make the necessary corrections, and release it to be processed.
NOTE: The CGS Advance Communication Engine (ACE) Smart Edits are also a part of the pre-adjudication process. Medicare Secondary Payer (MSP) Claim
If "Secondary" is selected at the top of the claim, the form will display a "Patient Relationship to Insured" field and "Insured Information" section located further down.
Under "Miscellaneous Claim Information," additional fields will display. Be sure to identify the Insurance Type Code.
NOTE: Refer to the "Eligibility"tab under the "MSP"sub-tab to locate the Insurance Type.
NOTE: The primary insurance EOB is NOT required. Include any attachments needed to support allowing the service(s) submitted.
RedeterminationsWhen you log into myCGS, you will find the FORMS tab. This option will allow you to access and submit CGS forms through myCGS. NOTE: Provider Administrators will have access to the tab by default. If the FORMS tab is grayed, please contact your Provider Administrator for access. Once logged in, select the Forms tab. Under the “Select a Topic” drop-down box, click “Redeterminations.” From the “Select a Type” drop-down box, click “Redeterminations.” Select the Redeterminations: 1st Level Appeal link located at the bottom of the screen.
You may also utilize the Appeals Calculator if you need help determining if your redetermination request is timely. By selecting the Appeals Calculator link, a new window will open. Enter the date of the initial determination of the service being appealed and click the Calculate! button.
The Appeals Calulator will display a date. The redetermination request must be received by the date displayed in order to be considered a timely request. If timely, return to the Redetermination screen to complete the form.
When completing the form, please note that fields with a RED* are required. This includes the beneficiary, provider and claim information. The specific service(s) being appealed must be added to the form by clicking the ADD button to populate the appropriate box. Also, identify whether the request is to appeal an overpayment. There is also an area to note the reason the redetermination request is being submitted. This field will hold up to 1200 characters.
Once the required fields are complete, select the VALIDATE button. myCGS will verify that all required fields are populated. When validated, a message will appear at the top of the screen inGREEN confirming this and the next steps prior to submitting the request. At least one attachment must be sent with the request. Examples of documentation needed to process the redetermination request includes medical records, operative/radiology reports,and other documentation to support the service(s) being appealed. You can attach up to five documents. Attachments can be up to 40MBs in size, not to exceed to total of 150MBs for allattachments. The documents must be in a PDF format. Click on the Browse button and a window will open allowing you to locate and attach the PDFdocument to the form.
Enter the name of the person requesting the redetermination in the NAME field. Click the Submit button when the form is complete and ready to be submitted.
An ‘e-signature’ box will appear, asking you to verify that the information entered and attachments are correct. This ensures the signature requirement for submitting a redetermination request has been met. If the information was entered correctly, and all desired attachments were included, click ‘OK’ to submit the form and all attachments. If corrections need to be made to the form or if any attachments need to be added or deleted, click ‘Cancel’ to return to the form. After submitting the form, you will be taken to the Message tab. Shortly after submission, you will receive a message confirming receipt of the Redetermination request. A separate messagewill be sent to your inbox, which will include a Submission ID assigned to your request. The Submission ID may be used to track the status of your request.
Please refer to the Messages tab of the myCGS User Manual for more details. Checking Redetermination StatusAppeals status is displayed under the Claims tab in myCGS. To view the status of an appeal:
The Detailed Claim Status Information page identifying the claim information now displays an Appeals window. If a 1st level appeal, Redetermination, has been requested on the claim, you will see this window populate.
In the Appeals window, you will see:
If the Redetermination is in a "Closed" status and the decision is Unfavorable, Partially-Favorable, or a dismissal, you may view the letter sent to you explaining our decision by clicking on the "View Decision Letter" link.
The decision letter is a PDF of the letter you receive via Green Mail or hardcopy. NOTE: A Fully-Favorable decision will not generate a letter. Please refer to your Remittance Advice to find the adjustment.
Submitting a 2nd Level AppealUse myCGS to submit a request for Reconsideration, the 2nd level of the Appeal process. A new Appeals window allows user to track the 1st and 2nd level appeals requested on the claim. From the Claim Status Information page, click on the claim number to view the claim details.
The Detailed Claim Status Information page identifying the information submitted on the claim now displays an Appeals window. If a 1st level appeal, Redetermination, has been requested on the claim, you will see this window populated.
If the Redetermination is in a "Closed" status and the decision is Unfavorable, Partially-Favorable, or a dismissal, you may view the letter sent to you explaining our decision by clicking on the "View Decision Letter" link.
NOTE: A Fully-Favorable decision will not generate a letter. Please refer to your Remittance Advice to find the adjustment.
If you disagree with the decision of your Redetermination as noted in the decision letter, you may request a Reconsideration of the Qualified Independent Contractor (QIC). The QICs for our jurisdiction are C2C Innovative Solutions, Inc. (C2C) and Maximus. Your request for Reconsideration may be submitted through myCGS! This is done by selecting the Submit a 2nd Level Appeal button located in the lower-right corner of the Appeals window.
The Reconsiderations form will display pre-populated with the details of your claim and User ID.
Complete the required fields including the reason you are submitting the Reconsideration request and attach any supporting documentation to the form. Once the Reconsideration is requested, you will see its status in the Appeals window directly below the Redeterminations information.
You will also receive confirmation in your Messages inbox that the request has been received. A second inbox message will be sent once the case is uploaded into our system and a Submission ID has been assigned.
When we process claims, occasionally our Medical Review (MR) department staff will need additional documentation from you in order to complete processing. This includes operative reports, plans of care, radiology/diagnostic reports, and other medical records. If/when the need arises, we will send you an additional documentation/development request (ADR) letter identifying the information needed to continue processing your claim. Under the "Medical Review" tab of myCGS, you have access to your MR Dashboard, allowing you to quickly identify MR ADRs sent to you. As an added convenience, you can perform several functions directly from your MR Dashboard, including:
Select the "Medical Review" tab to access your MR Dashboard.
ADR letters sent from our MR department will be listed by the claim number (Internal Control Number (ICN) or Document Control Number (DCN)) assigned to the actual claim. You may sort the list of claims by clicking the header to change the sort.
View an ADRTo view the details of an ADR, click on the claim number.
After selecting a claim number, the "Detailed Claim Status Information" page is displayed. Here you will find details specific to the ADR and claim, including:
Ask a General QuestionIf you have a general question regarding the ADR, you may select the "Ask a Question" button. Doing this will display an inquiry form pre-populated with details of the claim and ADR. Complete the remaining fields, attach any documentation you would like to send, and submit the form.
NOTE: As indicated at the top of the form, do not submit documentation in response to an ADR. This form is for general inquiries only. Respond to Pending ADRsAs an added convenience, you may respond to claims with a pending ADR status directly from your MR Dashboard.
NOTE: If you click on the claim number instead, the "MR Detail Claim Status" page will include an option to "Submit Documents," which will also allow you to access the auto-populated MR ADR Response Form. Additional OptionsDepending upon the status of the ADR, you may be able to perform additional functions:
No ADRsIf you find no ADRs on your MR Dashboard, a message will display to let you know.
Post-Pay ReviewYour MR Dashboard also allows you access to claims reviewed on a post-pay basis. To view, select the Post Pay Review Cases sub-tab.
Also, like the Medical Review Claims sub-tab, depending upon the status of the post-pay review, you will be able to complete other functions including asking questions and requesting a Redetermination or a Part B Reopening. When one of these options is selected, that form will open and auto-populate with information specific to the provider, claim, and the patient. Refer to sections above for additional information on other functions.
The "Remittance" tab of myCGS will allow you to view and print remittance advices for claims processed by CGS. Remittance Look-UpTo access your remittances:
NOTE: Remittances are readily available for approximately one year. If you need to retrieve remittances that are older than one year, myCGS may experience a delay. CGS does not guarantee access to remittances that are older than one year Once you have chosen the search option for remittances you want to view, click "Submit." Sorting and Viewing RemittancesRemittances that fall within your search option will display on the "Lookup Results" page. The remittance with the most recent date will appear at the top of the list.
Printing RemittancesOnce your remittance is displayed, you can print a copy by clicking on the "Print" icon located on the menu bar of the program used to view PDFs (e.g., Acrobat Reader, Microsoft Edge, etc.)
NOTE: If you do not have Acrobat Reader software, you can download it at no cost. You also may be able to view PDFs in your Internet browser. To enter new search criteria, click the "New Lookup" button.
The myCGS eligibility function is based on CMS' HIPAA Eligibility Transaction System (HETS). When you choose the "Eligibility" tab, you will see a new set of sub-tabs with information related to your inquiry. Information is presented on the following:
NOTE: myCGS uses CMS' HETS 270/271 system, as required by CMS, for all eligibility inquiries. Although myCGS pulls data from HETS in real time, the data available in the HETS 270/271 system is updated only at certain times. CMS currently pulls the updated data Tuesday through Saturday during the hours of 6:00 p.m. - 8:00 p.m. This data is then uploaded into HETS during the hours of 9 p.m. to 6 a.m. As soon as updated data is available in the HETS 270/271 system, users will be able to view it in myCGS. “Eligibility” TabTo access beneficiary eligibility information, click on the “Eligibility” tab. Once selected, myCGS defaults to the “Inquiry” sub-tab.
InquiryUse the “Inquiry” sub-tab to enter beneficiary information to submit an eligibility request. To ensure accurate information is provided to you, all fields entered, including optional fields, must be an exact match to the data maintained in CMS’ HETS. The following combination of fields are required:
The optional fields are not required to receive a valid Medicare beneficiary eligibility benefit response. If data is entered into an optional field, however, and the information does not match the beneficiary's data maintained in CMS’ HETS, eligibility data will not be returned on the eligibility response tabs. The optional fields are as follows:
Click “Submit Inquiry” to obtain eligibility information. Once retrieved, all the other sub-tabs will populate with data related to that beneficiary, if applicable. EligibilityThe "Eligibility" sub-tab provides information regarding the beneficiary's Medicare coverage. If information does not populate, for example, either the "Part A Eligibility" or "Part B Eligibility" benefit information, it means the beneficiary is not eligible to receive Medicare benefits for the requested period on the inquiry screen.
The following tables provide information for the "Eligibility" sub-tab fields: Part A Eligibility Benefit Information
Part B Eligibility Benefit Information
Inactive Periods
Beneficiary Address
End Stage Renal Disease (ESRD) Information
NOTE: The ESRD section displays only active ESRD data and will not be available if no notification has been received by CMS indicating an ESRD period is active and in effect per the date(s) requested. MBI End Date Medicare Diabetes Prevention Program (MDPP)
Deductibles/CapsThe “Deductibles/Caps” sub-tab provides information regarding the beneficiary’s Part B deductibles, co-insurance, occupational/physical/speech therapy caps, and other services.
The following tables provide information for the “Deductible/Caps” sub-tab fields: Part B Deductible
Part B Remaining Deductible
Co-insurance Details
Blood Deductible
Occupational Therapy Cap
Physical and Speech Therapy Cap
Pulmonary Rehabilitation Services
Cardiac Rehabilitation Services
Intensive Cardiac Rehabilitation Services
Part B Free Services
Mental Health Co-insurance
PreventiveThe "Preventive" sub-tab provides information regarding preventive services the beneficiary has received. Specific CPT/HCPCS codes and the dates the beneficiary is next eligible to receive services are listed as appropriate. NOTE: Only HCPCS codes for which a beneficiary is eligible will be displayed and grouped together under their appropriate categories. If a service has been rendered, it is removed from the list until closer to the time the beneficiary is eligible to receive the service again.
The following tables provide information for the "Preventive" sub-tab fields: COVID-19 Immunization myCGS will display the most recent information for the COVID-19 vaccine and its administration.
Smoking Cessation Information
Pneumococcal Vaccine (PPV) Accupuncture Effective for claims with dates of service (DOS) on and after January 21, 2020, Medicare will cover acupuncture for chronic Low Back Pain (cLBP)
Deductible Remaining by Spell
Plan CoverageThe “Plan Coverage” sub-tab provides information regarding the beneficiary’s enrollment under Medicare Advantage (MA) Managed Care Plans (commonly referred to as Part C contracts) that provide Part A and B benefits for beneficiaries. This sub-tab also provides information on a beneficiary’s Part D prescription drug coverage. NOTE: Whenever myCGS indicates that a beneficiary has coverage through a non-Medicare entity (MA or Medicare Drug Benefit plans), the inquiring provider should always contact the non-Medicare entity for complete beneficiary entitlement information.
The table below describes the “Plan Coverage” sub-tab fields:
When a beneficiary has a primary payer other than Medicare, the “Medicare Secondary Payer (MSP)” tab provides the beneficiary’s primary insurance information. MSPThe “MSP” sub-tab is populated if the beneficiary has a payer that processes claims primary to Medicare. This sub-tab displays only active MSP data and will not be listed if there is no MSP data or if notification of coverage primary to Medicare has not been received by CMS. NOTE: If a date range is entered on the “Inquiry” screen, it will affect the MSP data returned.
The table below describes the “MSP” sub-tab fields:
Hospice/Home HealthThe Home Health Care section provides information for each episode start and end date and the corresponding billing activity dates. The Hospice section provides eligibility information when the hospice benefit is effective and when it terminates, in addition to the total hospice occurrence count for the listed beneficiary. If the patient has any gap in their episode of care or changes providers at any time, or if their hospice provider has sent the final claim revoking hospice care, you will see more than just a single effective date being returned. Once the final claim has been submitted, the hospice termination (or revocation) date is returned, along with the revocation code. If the patient is still in hospice care, but has changed providers, the start and termination date with each provider will be returned. Therefore, if no termination date is returned, it is to be assumed that the patient is still under hospice care, as no claim has yet been processed that revokes that period of care. NOTE: The "Hospice/Home Health" sub-tab displays hospice and/or home health data and will not be accessible when there have been no claims received by CMS indicating hospice or home health coverage is active and is in effect per the date(s) requested. To make sure you see all the information, enter a date range in the inquiry screen.
The tables below describe the "Home Health/Hospice" sub-tab fields: Home Health Care
Hospice
myCGS will display up to 50 billed Hospice episodes that occurred in the last four years. InpatientThe “Inpatient” sub-tab includes Inpatient, Skilled Nursing Facility (SNF), and Psychiatric Benefit Data sections. The Inpatient section provides hospital inpatient benefit and billing information. The SNF section provides SNF benefit and billing information. NOTE: While the Psychiatric Benefit Data section now displays in myCGS, the data is not yet available in CMS’ HIPAA Eligibility Transaction System (HETS) 270/271 system that we are required to access for eligibility. The system will return hospital inpatient default deductibles based on the requested start year when the following occurs:
In addition, the system will continue to return the hospital inpatient default deductible remaining amounts, inpatient co-payment days, and SNF co-payment days based on the beneficiary’s Part A entitlement start year when the following occurs:
NOTE: Depending on the date(s) range requested, multiple inpatient and SNF spells might be displayed. The data returned on this screen is directly impacted by timely submission of claims by the provider. The data returned is compiled from claims that have been processed by the Common Working File (CWF). To make sure you see all the information, enter a date range in the inquiry screen. If a single hospital inpatient/SNF spell spans more than one calendar year, myCGS will return the daily co-payment amounts associated with the beginning year of the spell.
The table below describes the “Inpatient” sub-tab fields: Part A Deductible
Part A Base Deductible Remaining
Deductible Remaining by Spell
Inpatient Spell Dates
Inpatient Base Summary
Inpatient Days Remaining
SNF Base Summary
SNF Days Remaining
Lifetime Reserve Days
Lifetime Psychiatric Benefit Data
Part A Free Services
QMBBeneficiaries who are enrolled in the Qualified Medicare Beneficiary (QMB) program are dually eligible for both Medicare and Medicaid. Those enrolled in this State Medicaid benefit, which assists low-income Medicare beneficiaries with Medicare Part A and Part B premiums and cost-sharing (deductibles, co-insurance/co-pays), are not liable financially. QMB status may fluctuate for a minority of beneficiaries. If eligibility results indicate the beneficiary QMB enrollment has terminated, please verify the patient's QMB status through online State Medicaid eligibility systems or other documentation, including Medicaid identification cards and documents issued by the state proving the patient qualifies for the QMB program. The “QMB” sub-tab includes Medicaid Enrollment, Part A Deductible, Inpatient, Skilled Nursing Facility (SNF), Part B Deductible, and Part B Co-Insurance sections. NOTE: "$0" will display in the deductible, co-insurance, and co-pay sections for beneficiaries enrolled in the QMB program.
What Is the Medicare Beneficiary Identifier?As a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the social security number-based Health Insurance Claim Number (HICN) was removed from the Medicare card and replaced with the new Medicare Beneficiary Identifier (MBI). All Medicare beneficiaries were mailed new Medicare cards identifying their newly assigned, system-generated MBIs. Beginning January 1, 2020, the MBI is used in all Medicare transactions in place of the HICN. Using the MBI Look-Up ToolIf you need to obtain a patient's MBI:
Under the "Financial Tools" tab of myCGS, you have access to the following:
Cash Flow SnapshotTo access your financial information:
Payment Floor StatusMedicare contractors are required to hold payments for a minimum predetermined number of days. The payment floor for electronic claims is 14 days, 29 days for paper claims. This section refers to all claims approved for payment waiting to be released from the payment floor as of the current date.
NOTE: The number and total dollar amount of claims on the payment floor could change daily. Claims will continue to be added to the payment floor as they are approved; some will be paid from the payment floor once they reach day 14. Last 3 ChecksYou will find a list of the last three checks issued to the billing provider. The dates and amounts of the checks are identified here.
Financial FormsOn the “Financial Forms”sub-tab, Part A and Home Health Agencies (HHAs) can submit CMS-838 Credit Balance reports. Available to all providers is the Immediate Offset (eOffset) request form.
CMS-838 Credit BalancePart A and Home Health Agencies are required to submit quarterly Credit Balance reports within 30 days after the close of each calendar quarter. myCGS may be used to submit the actual CMS-838 form NOTE: A Medicare Credit Balance is an amount determined to be refundable to the Medicare program for an improper or excess payment made to a provider because of patient billing or claims processing errors.
Attachments You may attach files to your submission by selecting the “Browse” button. Each file may be up to 40MB. The combined size of all attachments cannot exceed 150MB. The attachments must be in PDF format and created using appropriate PDF creation software. Failure to create the PDF correctly can result in a corrupt file that could prevent you from successfully submitting the claim through myCGS. NOTE: CMS regulations prevent CGS from accepting electronic signatures; therefore, the first attachment must be the signed CMS-838 Credit Balance form.
Signature/Contact Enter the name and title of the person authorized to submit the report. The contact information may be pre-populated based upon your User ID. If the form and attachments are accurate, check the box to certify. Click “Submit” to send the form.
Confirmation Messages You will receive messages regarding your submission through myCGS in your inbox under the “Messages” tab. The first message is the submission confirmation. This message confirms that the form was sent. A second message will be available once the form is accepted. It will include instructions on how you can use the submission ID assigned to the case to check the status. Immediate Offset (eOffset)myCGS allows you to submit an electronic authorization allowing us to offset funds to satisfy a pending overpayment due using an electronic eOffset Request Form. This authorization may be submitted each time a demanded overpayment is received, or you may authorize a permanent request for all future demanded overpayments. You may also monitor the status of the requests submitted through myCGS.
Once you select an option, a disclaimer box will display to confirm timeframes and to ensure you have selected the correct form.
Provider Level OffsetAfter accepting the disclaimer, the Provider Level Offset form will display. Most fields will show be pre-populated with information based on your provider and User ID. You must complete the remaining fields.
After completing the required fields, click “Submit”to send the request for automatic offset for future overpayments. An e-signature box will appear, asking you to verify that the information entered is correct. This ensures thesignature requirement for all requests have been met. Click “OK” if you agree or “Cancel”to return to the form to make changes/corrections.
After submitting the form, you will be taken to the “Messages”tab. Shortly after submission, you will receive a confirmation message acknowledging receipt of the eOffset request. A separate message will be sent to your inbox that will include a submission ID assigned to your request. This ID may be used to check the status of your submission. Demand Level OffsetWhen selecting the option for a one-time immediate offset, a window will display, allowing you to submit your request based on either the offset letter you received from CGS or up to 10 Accounts Receivable (AR) numbers identified on an attachment to the demand letter.
Selecting the “Letter” option allows you to enter the number located in the upper-right header area of the demand letter to request the immediate offset.
Selecting the “AR” option allows you to request a one-time immediate offset using the accounts receivable (AR) number assigned to the request.
Stop Provider Level Offset Previously RequestedThis form is to be used when you’ve previously submitted the Provider Level Offset form to authorize the immediate offset of all future demands but would now like to cancel that request. When you select this option, a message will display, informing you of critical time periods associated with your request. If you agree, click “OK.”
The "Messages" tab of myCGS will allow you access to a secure messaging system within myCGS. This messaging system will send messages and alerts regarding system access and functions performed while in myCGS. For example, when you submit a redetermination through myCGS, a confirmation message is delivered to your myCGS inbox, letting you know it was received and accepted for processing. Message InboxYou may access the messages sent to you/your PTAN/NPI by either selecting the “Messages” tab located in the menu or clicking Retrieve Messages displayed in the Message Bar. The Retrieve Messages link is accessible from all tabs.
Both options will take you directly to your Message Inbox. Inbox FoldersmyCGS defaults to display all messages delivered to your inbox. Each message is also sorted to its corresponding folder, allowing you quick access to view a specific type of message. The folders available are:
To find a specific type of letter sent to your PTAN/NPI, go to the appropriate folder. For example, to find a letter sent to your PTAN/NPI requesting additional documentation to complete processing of a submitted claim, go to the ADR folder. There you will find all messages that include the additional documentation/development requests sent to the PTAN/NPI.
NOTE: Messages will be automatically moved to the ARCHIVED MESSAGES sub-tab after 60 days. Messages will NOT be available after 365 days. Inbox FilteringInbox Filtering is available to allow you to search your inbox for a specific message or letter. You may filter your inbox by:
*Green Mail letters may be filtered only by date, submission ID, and E-Letters options. Messages may be filtered by ALL options.
Select your filtering option, enter the criteria, then click the “Filter” button.
NOTE: Confirmation messages for Claim Inquiries you submit are not available when you filter by MBI or Claim Number; however, the confirmations can be found in the Claim Inquires inbox folder. Viewing MessagesYour inbox will default to a date sort so that all messages are in order by date of receipt. You may change the sort by clicking on the column headers for subject or submission ID.
Your inbox also includes pagination, allowing you to change the number of messages viewed on a page (located at top), and quickly move through multiple pages (located at bottom).
To view a message, click on the link in the “Subject”column. A window will open, providing instructions and a link to the actual correspondence. Click on the link to view.
To save a step, you also have the option to download a PDF copy of the letter directly from your messages Inbox. Click on the download icon located in the “Submission ID” column.
Either way, a PDF copy of the correspondence mailed to you will display.
NOTE: Messages delivered to your inbox that include correspondence specific to a particular workload will also be mailed to you hardcopy if your organization has not opted in for Green Mail. Messages received as a result of forms submitted to us for processing will have a subject, “Form Received,” to advise you that your submission has been received. It will not display a submission ID until one has been assigned by CGS. Once CGS has assigned the submission ID, you will receive another message with a link, “Secure Form Confirmation,” under the “Subject” column. Click on this link to view the message. The message identifies the unique identifier assigned to your request (e.g., Appeal DCN) and includes instructions on how to use the identifier to track the status of your request. Archiving MessagesTo maintain your inbox, you have the option of archiving messages. To archive a message or multiple messages, check the box of the message and click the “Archived Selected” button. NOTE: Messages will be automatically moved to the ARCHIVED MESSAGES sub-tab after 60 days.
A message will display asking you to confirm. Click “OK” to archive the message.
To access archived inbox messages, select the “Archived Messages” sub-tab.
NOTE: You may use the Inbox Folders and filtering options to locate archived messages. Messages delivered to your inbox that include correspondence specific to a particular workload will also be mailed to you hardcopy if your organization has not opted in for Green Mail. Deleting MessagesYou also have the option of deleting messages from either your inbox or under the “Archive” tab. To delete a message or multiple messages, check the box of the message and click the “Delete Selected” button.
A message will display asking you to confirm. Click “OK” to delete the message. Deleted message may not be recovered.
NOTE: Messages will NOT be available after 365 days.
The "Forms" tab allows providers to submit certain types of requests directly to CGS through the myCGS web portal safely and securely. Most forms are pre-populated with information specific to your account, reducing the amount of time it takes to complete and submit them. You are also able to attach additional documentation that will be used for processing. Forms Available in myCGSThe forms available in myCGS may vary based on your line of business (i.e., Part A, Part B, Home Health, Hospice). They include the following:
* Form is located under the "Financial Tools"tab ** Form is located under the "Claims"tab Accessing myCGS FormsSelect the "Forms"tab to access the "Secure Forms"page.
You may also access the "Secure Forms"page by selecting the "Go To Page"drop-down box. This is also a way to access the "Financial Forms"sub-tab.
Once on the "Secure Forms" page, you will find an option to "Select a Topic." Options in the drop-down box include Redeterminations, Reopenings (for Part B), Audit & Reimbursement (for Part A and HHH), Medical Review, and Provider Contact Center.
NOTE: Provider Administrators have access to all tabs within myCGS. Provider Users have access to only the tabs the Provider Administrator has granted permission to access. If you have access to the forms available in myCGS, the ‘Forms,’ ‘Financial Tools’ and ‘Claims’ tabs will be visible once you successfully log into the portal. If a tab is grayed out, but you believe you need access to the tab, contact your Provider Administrator. RedeterminationsProviders and beneficiaries may appeal an initial claim determination when Medicare's decision is to deny or partially deny a claim. The first level of the appeal process is a redetermination. You have 120 days from the date of receipt of the notice of initial determination to submit a request. There is no monetary threshold. For instructions, please refer to the job aid for your line of business: HHH, Part A, Part B Reopenings (Part B)Part B Reopenings may be accepted to correct minor errors and omissions on previously processed claims. Requests must be submitted within 12 months of the original claim remittance date. Separate job aids are available to make corrections to dates of service, place of service, modifiers, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) codes, billed amounts, and more. Audit & ReimbursementPart A and HHH providers are required to submit financial data that support amounts claimed in a cost report directly to CGS. This financial information is reviewed and processed by our Audit & Reimbursement team. This sensitive information and other correspondence may be submitted securely through myCGS. Instructions are available to help with navigation: myCGS Enhancement: Audit & Reimbursement (A&R) Secure Messaging Part A providers are required to submit financial data, which supports amounts claimed in a cost report, directly to CGS. This financial information is reviewed and processed by our Audit & Reimbursement (A&R) team. NOTE: Per the Centers for Medicare & Medicaid Services (CMS), cost report submissions are no longer accepted through myCGS, or this enhancement. Please refer to MLN Matters® article MM10611 To submit information using this enhancement: Step 1: Once you are logged into myCGS, select the FORMS tab. Step 2: From the 'Select a Topic' drop-down menu, click the 'Audit and Reimbursement' option. Step 3: From the 'Select a Type' drop-down menu, click the 'A & R Correspondence Part A' option. Step 4: Click on the 'A & R Correspondence link to view the form.
Once the form loads, you will find some information pre-populated with identifying information for your PTAN/NPI. Step 5: From the 'Fiscal Year End Date' field, select the date from the calendar icon or enter the fiscal year end date in the XX/XX/XXXX format.
Step 6: Enter the name of the specific CGS employee for whom the correspondence is being sent. Step 7: In the 'Workload' field, click the drop-down box to select the subject of your correspondence. The options available are:
NOTE: Please refer to MLN Matters® article MM10611
Attach the documents you want to include with your submission. You may attach up to 10 documents. Each attachment must be in one of the following formats and can be up to 40 MBs in size. The total size of all attachments cannot exceed 150 MBs. NOTE: At least ONE attachment must be submitted. Document format types accepted through Secure Message:
Step 8: Click the 'Browse' button. A window will open allowing you to locate the document stored on your system. Once you locate the document click "OPEN" to attach it to the form. A status bar (in BLUE) will appear indicating the document is uploading.
All files attached will appear under "Attached Files." If a file is attached in error, simply click the RED 'X' in the 'Action' column to remove it. Once the form is complete, enter your name and hit SUBMIT to send the form and its attachments. Once received, confirmation will be delivered to your secure inbox letting you know. Responses sent to you by our A&R team will also be delivered to your inbox. Comparative Billing ReportsComparative Billing Reports (CBRs) are created to give you a snapshot of your specific billing pattern data in comparison to peer groups within your CGS jurisdiction. This information is helpful in conducting education and self-audit activity. Details on requesting this data is available for your line of business: HHH, Part A, Part B Home Health Agencies (HHAs) also have access to Request for Anticipated Payment (RAP) CBRs. The RAP CBRs will allow HHAs to monitor the percentage of RAP ratios. Responding to Requests for Additional DocumentationThe myCGS web portal allows you to respond to our additional documentation request (ADR) letters directly from your MR Dashboard and Claims tab. MR Dashboard:
You can also access the form if you are on the 'Detailed Claim Status Information' page by clicking the 'Submit Documentation' button.
For your convenience, the MR ADR form will auto-populate with information in most of the required fields. Claims Tab:
To save you time, the form will auto-populate with information in most of the required fields. When claims are pending due to an ADR, do not use the 'Ask a Question' button, as it will not route the documentation you attached to the pending claim. Reconsiderations (HHH and Part A)Home Health, Hospice, and Part A providers may request a reconsideration(a second-level appeal) through myCGS. The request must be submitted within 180 days from the date of receipt of the redetermination decision. In cases where the redetermination request is dismissed, a reconsideration may be requested within 60 days of the dismissal notice. The form is available under the “Claims”tab for claims that have completed the first-level appeal, redetermination. HHH, Part A General InquiriesYou may submit general questions through myCGS related to various topics, including appeals, finance, education, and medical review. The form is available for each line of business: HHH, Part A, Part B Immediate OffsetAn immediate offset is your electronic authorization allowing us to offset funds to satisfy an overpayment requested by CGS. You may request an immediate offset each time a demanded overpayment is received or authorize a permanent request for all future demanded overpayments. The forms are located under the “Financial Forms”sub-tab. Instructions on completing the forms are available in the myCGS Financial User Manual NOTE: Provider Administrators have access to all tabs within myCGS. Provider Users have access to only the tabs the Provider Administrator has granted them permission to access. If you have access to the forms available in myCGS, the “Forms,” “Financial Tools,” and “Claims” tabs will be visible once you successfully log into the portal. If a tab is grayed out but you believe you need access to the tab, contact your Provider Administrator. Credit BalanceA Medicare credit balance is an amount determined to be refundable to the Medicare program for an improper or excess payment made to a provider because of patient billing or claims processing errors. Each HHH and Part A provider must submit a quarterly Credit Balance Report (Form CMS-838). To ensure timely receipt and processing, myCGS is the preferred method of submission. The form is located under the “Financial Forms”sub-tab. Instructions to help with completion are available to you: HHH, Part A Overpayment Recovery Request (Part B)Part B providers may submit an Overpayment Recovery Request to notify us of an overpayment. Doing this will generate a demand letter identifying the amount to be refunded. Once the request is received, approved, and processed, we will issue an overpayment demand letter. The debtor has 30 days from the date of the demand letter to submit the refund. (See Immediate Offset to avoid delays and possible interest added to the principle balance.) Once you are logged into myCGS, select the FORMS tab.
Prior Authorization (PA) for Certain Hospital Outpatient Department (OPD) Services (Part A)CMS implemented a prior authorization process for certain services provided in the outpatient department of the hospital. This process requires OPDs to submit requests for provisional affirmation of coverage to be reviewed BEFORE the applicable services is furnished. PA requests may be submitted through myCGS and is available to users registered as Part A providers. NOTE: This is a Part A requirement. Users registered under Part B do not have access to this form. Instructions to help with completion of the PA form are available: Part A Completing a FormYou will find the form you select is pre-populated with information specific to your account, including the provider name, PTAN, and NPI. Complete the remaining fields of the form. Those fields that are required are marked with a red asterisk (*). Attachments SectionMost of the forms in myCGS give you the option to attach additional documentation (e.g., medical records, operative/radiology reports, attestations) you would like CGS to consider when processing your request. You may attach up to 10 documents. Each document must be in a PDF format and can be up to 40MB. The total size of all attachments cannot exceed 150MB. To add an attachment, select the “Browse” button, and a window will open, allowing you to locate the PDF document you wish to add. Select the PDF document to attach it. Repeat this process for each additional PDF document you wish to attach.
Submitting a FormOnce all required information has been entered, and all necessary PDF documents have been attached, click “Submit.” An e-signature box will appear, asking you to verify that the information entered and documents attached are correct. This ensures thesignature requirement for all forms have been met. If the information was entered correctly, and all desired attachments were included, click “OK” to submit the form and all attachments.
If any information needs to be corrected, or if any attachments need to be added or deleted, click “Cancel” to return to the form.
myCGS will generally be available 24 hours a day, seven days a week. However, access to myCGS does not guarantee that all functions will be available. See available times below. If you need technical assistance with myCGS, please contact the EDI Help Desk:
Refer to the availability times below for times when each function is available.
If scheduled myCGS maintenance is required, it will be performed during the times listed below:
Our goal is to avoid any service interruptions during normal operating hours. However, unscheduled maintenance may be necessary in order to immediately address systems security threats or performance issues. When you access myCGS and it is not available, you should see a page that indicates maintenance is in progress. Also, refer to the myCGS Status Page for reported issues and updates.
As the Provider Administrator of your organization/office, you have a very important role. You will be able to perform functions that Provider Users cannot. Provider Administrators are responsible for managing all access and ensuring only authorized individuals have access to the sensitive information available through myCGS. The Provider Administrator's role involves adding and deleting users, assigning additional Provider Administrators, authorizing access to functions, unlocking accounts, and recertifying user access. NOTE: CGS suggests there be at least two Provider Administrators established for each PTAN/NPI combination to be responsible for maintaining portal access for the office/organization. The "Admin" TabOnly Provider Administrators have access to the "Admin" tab, which is in the header of myCGS.
The screen defaults to the Provider User Listing. This page lists all admins and users registered under your PTAN/NPI. Unlocking AccountsAll myCGS users (Provider Administrators and Provider Users) are required to log into myCGS at least once every 30 days. Inactivity results in the ID being disabled. (If the inactivity continues, the ID will eventually be terminated.) Users will receive an e-mail informing them if their account is disabled.
Also, myCGS IDs will be locked upon three unsuccessful login attempts within a 120-minute time span. Provider Administrators are responsible for unlocking accounts disabled for these reasons. To unlock an account:
Account RecertificationTo ensure all myCGS users are compliant with updated Centers for Medicare & Medicaid Services (CMS) security requirements, account recertification will be required to be completed by the Provider Administrator. This task must be completed every 360 days. Notification pop-up messages will display upon login within 47 days of the date recertification is due.
Failure to complete the process timely will result in an interruption of service, including deactivation. The user cannot access myCGS until the recertification is completed. This process applies to the Provider Administrator as well.
To recertify an account:
NOTE: These steps would apply if the Provider Administrator is recertifying his/her own access to myCGS. Adding New UsersWhen adding new Provider Administrators and Provider Users to your account, each user must have a unique User ID and password. The User ID must be created with the user’s actual first and last name. Generic first and last names are not permitted. User IDs and passwords should never be shared. Examples of unacceptable user names:
To add a new user:
Modifying User AccountsIf a user’s role has changed and you need to allow or remove permissions for performing certain myCGS functions, as Provider Administrator, you may modify user accounts. To edit an account:
Deleting a UserThe Provider Administrator is responsible for managing myCGS access for the entire office/organization. This includes deleting users who no longer need access to the portal.
Green MailmyCGS allows Provider Administrators to select the Green Mail option, which is a function that allows myCGS users IMMEDIATE access to correspondence sent from CGS. This includes:
Notification is delivered to the myCGS “Messages” tab of users registered under a specific PTAN/NPI combination. To ensure you receive the notification, users are also sent an e-mail to the registered e-mail address, informing them that notification has been delivered to the myCGS inbox. Options for Green Mail are:
The "My Account" TabSelect the "My Account" tab to access your myCGS information.
Account InformationAfter clicking on the tab, myCGS defaults to the “Account Information”sub-tab, which identifies the name(s) of your Provider Administrator(s) along with a link to contact him/her via email. You will also find your account information, which includes your name, validation questions and answers, business address, and Multi-factor Authentication (MFA) Set-up section.
Validation Questions & AnswersDuring the registration process, you were prompted to select six questions and provide answers to those questions. The purpose of the questions is to validate your identity should you forget your password and need to reset and enter a new one. Under the "Account Information" sub-tab, you may change the questions you selected originally and provide new answers.
NOTE: There are a total of six validation questions, so be sure to complete all six question and answer fields. Contact InformationYour contact information associated with the account is also available under the "Account Information" sub-tab. This information was added during the registration process. You may change your contact information as needed.
Multi-Factor Authentication (MFA)CMS requires us to implement an additional level of security when accessing myCGS due to the amount of sensitive information accessible through the web portal. The MFA process meets that requirement, as users are required to enter an eight-digit code before gaining access to myCGS. During the registration process, you identified whether you wanted to receive your MFA code via e-mail, text, or both. This option can be changed under the "Account Information" sub-tab. If you want to add the text option, complete the "Mobile Phone" and "Carrier" fields located at the bottom of the page.
Google Authenticator (GA)Instead of receiving your MFA code via text or email, you may use the Google Authenticator (GA) app. The app is available for download on your desktop computer/laptop or mobile devices. For mobile devices (i.e., cell phones, tablets) you may download the app from the App Store (Apple) and Android Play Store (Android). To install GA onto your desktop computer/laptop:
For instant access, we suggest you pin the GA icon to the toolbar.
Log into myCGS, go to the “My Account” tab, and complete the steps based on the browser you use. To install the Google Authenticator mobile app and link it to myCGS:
TIPS
Confirm/Verify ChangesWhen changes (such as those noted above) are made to the "Account Information" sub-tab, you must save your changes.
Account LinkingmyCGS requires users to maintain separate User IDs for each PTAN/NPI combination. If you manage multiple accounts, you have multiple User IDs. Account Linking allows you to combine multiple User IDs under one Super ID. From your new Super ID, you can select one of your linked accounts to perform functions available under that PTAN/NPI. NOTE: User IDs linked to your selected Super ID must be active. If, for example, the User ID has been terminated due to inactivity, was not recertified by your Provider Administrator, did not receive timely profile verification, or was terminated by your Provider Administrator, it cannot be linked to your Super ID. To link an account:
Account Linking Tips!
Change PasswordmyCGS requires that you change your password at least once every 30 days. You will receive reminders as the date nears. If your password is compromised, you are encouraged to change your password immediately instead of waiting for the 30-day notification. To change your password:
Profile VerificationTo meet CMS security guidelines, all users must verify that the information on his/her profile is accurate and current. This process is required every 250 days. myCGS tracks this timeframe to ensure this task is completed. NOTE: If you have multiple accounts and IDs and selected one as your Super ID (see Account Linking above), Profile Verification is performed on just the Super ID and not the accounts linked to the Super ID.
myCGS User ManualThe myCGS User Manual provides detailed information about accessing and obtaining information from the myCGS web portal. The User Manual is aligned with the various Tabs available in myCGS. As a reminder, myCGS users are assigned rights to the Tabs by their myCGS Provider Administrator. Therefore, a myCGS user may not have access to all Tabs in myCGS. |
