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January 29, 2016

J15 Part A: Change in Medical Review Contact Number

CMS requires all Medicare contractors to have a Provider Customer Service Program (PCSP) to assist providers in understanding and complying with Medicare's operational processes, policies, and billing procedures. The primary responsibility of the PCSP is to enable providers to understand, manage, and bill the Medicare program correctly, with the goal of reducing the Medicare paid claims error rate and improper payments.

Effective February 1, 2016 all questions regarding medical review decisions of claims should be directed to the Provider Contact Center (PCC) at 866.590.6703. Select Option 1 to speak with a Part A Customer Service Representative for assistance with Part A billing, payment, or other claims questions.

Before you call:

  • Check the CGS website; the answers to many of the most common questions are found here. Tip: narrow your search results to include only "Part A" articles.
  • FAQs and the Claims Processing Issues Log are two good resources.
  • Obtain information electronically (including duplicate copies of remittance advices, extensive beneficiary eligibility information, file offset requests, respond to MR Additional Documentation Requests (ADRs) and submit first-level appeals (redeterminations) through our free web portal, myCGS. Tip: you must be an electronic submitter to register for and use this portal.

This change is being implemented to improve customer relations for the providers of Medicare services under the J15 Part A contract in Kentucky and Ohio. 

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