Corporate

Self-Service Options

The following tools are designed for Part A providers who submit claims to CGS.

Tool

Description

277CA Edit Lookup Tool

Allows Trading Partners, billing services, providers, and clearinghouses to view easy-to-understand descriptions associated with the edit code(s) returned on the 277CA – Claim Acknowledgement for 5010A1 claims.

Additional Development Request Timeliness Calculator

The ADR timeliness calculator will assist you in determining the date ADR documentation must be received in order to meet the time frame for submission.

NEW! Appeals Decision Tree

Follow this decision tree to determine if you need to request a reopening or a redetermination.

Appeals Timeliness Calculator

Determine the date your appeal request must be received in order to meet the timeliness guideline.

NEW! Average Provider Enrollment Applications Processing Time

CGS Provider Enrollment now provides average enrollment application processing times so you will know how long it takes to complete the enrollment process. Use this tool to access details and average processing times for your application.

CERT Claim Identifier Tool

Determine the outcome of a CERT reviewed claim, and the reviewer's comments for a claim denied by CERT. Simply enter the Claim Identifier (CID) number assigned to the claim by CERT.

CGS GO Mobile App

CGS is keeping you connected with our free CGS GO Mobile app! Now, you can access contact information, CGS monthly Bulletins, MLN Connects, physician fee schedule information, and read LCDs, related policy articles and more! Download today!

CGS Provider Enrollment Application Status

Enter the Reference Number from your acknowledgment letter and the 5-digit Zip code of the contact address to check the status of your enrollment application.

EDI Report Request Tool

Allows providers to request a claim response report, or an electronic remittance advice.

Interactive UB-04 Claim Form

Provides instructions on completing the UB-04. Click on each field to see if it is required, not required, or situational.

Interactive Voice Response (IVR) System

Access the Part A IVR system at 1.866.289.6501 for claim and redetermination status, beneficiary eligibility, financial, and general information. The IVR is available 24/7. Refer to the IVR User Guide PDF for additional information.

New! IVR and CTI Converter Tools

The Interactive Voice Response (IVR) and Computer Telephone Integration (CTI) systems require entry of your patient's name and Medicare number during the beneficiary validation process.  This tool:

  • Converts the beneficiary's first initial of their first name and first six letters of their last name to the numbers necessary to enter on your telephone keypad.
  • Converts the 11 digit alpha/numeric Medicare Beneficiary Identifier (MBI) to the numbers/characters necessary to enter on your telephone keypad.

Medicare Deductible / Coinsurance Look-Up

Medicare beneficiaries who receive covered Part A services may be subject to deductible and coinsurance.  Covered Part B services are subject to an annual deductible and coinsurance.  Select the year from the drop down menu to access deductible and coinsurance amounts for that Calendar Year.

Medicare Secondary Payer Billing & Adjustments Quick Resource ToolPDF

This tool is a flow chart that guides you to appropriate data elements that are required on your claim based on the type of MSP record.

Modifier Finder Tool

This Part A Modifier Finder tool has been designed to aid Medicare providers in using modifiers correctly. You may search this database by modifier or keyword. All records matching your search criteria will be returned for your review. Or, if you wish, you may also view the entire listing of modifiers, their definitions, and additional billing information by clicking on the "Show all Modifiers" option.

myCGS

myCGS is a web-based application developed specifically to serve the needs of health care providers and their staff. Access to myCGS is available 24/7, and is free of charge.

myCGS Comparative Billing Reports (CBR) for Part A Providers

The purpose of the Comparative Billing Report (CBR) is to show provider specific pattern data in comparison to peer groups within your state and the CGS jurisdiction. This information is helpful in conducting education and self-audit activity. Refer to the CBR Job Aid for more information.

Provider Enrollment Interactive Help Tool

This interactive tool is designed to walk you through the application process simply by asking you a series of questions. Feel confident that you are selecting the correct CMS-855 application, completing the sections applicable to your situation, including the supporting documentation, and accessing other forms needed to complete your enrollment.


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