Skip to main content
Corporate

February 20, 2015 - Revised: 12.27.18

Checking Claims Status

Use one of the following self-service options to check the status of your claim:

  • Call the Interactive Voice Response (IVR) at 1.866.289.6501. The IVR provides the status of a claim (e.g., processed, pending, denied, returned to provider, rejected), the date it was received, type of bill, claim location, and total charges. For additional information on using the IVR, access the Part A IVR User GuidePDF.
  • Access the Fiscal Intermediary Standard System (FISS) via Direct Data Entry (DDE):
    1. From the FISS Main Menu, select 01 "Inquiries."
    2. From the Inquiry Menu, select 12 "Claim Summary."
    3. From the Claim Summary Inquiry screen, enter your facility's NPI in the NPI field and the beneficiary's Medicare ID Number in the MID field.
    4. Press Enter.

      For additional information, reference the DDE User Manual - Inquiry Menu - Chapter 3PDF.

  • Access the myCGS portal Claims Tab. For additional information, reference the myCGS User Manual.

Timeliness Standards

Timely standards for processing claims without interest being applied to a claim:

The "payment floor" establishes a waiting period during which time the contractor may not pay, issue, mail, or otherwise finalize the initial determination on a clean claim.  The "payment floor date" is the earliest day after receipt of a clean claim that payment may be made.

The payment floor date is determined by counting the number of days since the day the claim was received, (i.e., the count begins the day after the day of receipt). The waiting periods are:

Electronic Claims: 13 days
Paper Claims: 26 days

Interest on Clean Claims

Interest must be paid on clean claims if payment is not made within the applicable number of calendar days (i.e., 30 days) after the date of receipt as described above. For example, a clean claim received on January 1, 2018, must have been paid before the end of business on January 31, 2018.

If a clean claim is submitted to Medicare, payment cannot be made until at least 13 days for electronic claims or 26 days for paper claims; however, the contractor has 30 days to process clean claims before interest is applied.

NOTE: The Provider Contact Center (PCC) is not able to assist with claim status inquiries related to claims that have been suspended for less than 30 days (new claims) or 60 days (adjustment claims).

Reference:

Was this page helpful? YES NO


26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved