Written Inquiries Data
For provider inquiry analysis, CGS maintains a systematic and reproducible provider inquiry analysis program for written inquiries. We review the top reasons you write to us and use that information to develop and implement resources to address the needs of our providers.
Before you write to us, please be sure you are sending correspondence to the correct department and address. Check here to avoid misrouted written inquiries by selecting the "Mailing Addresses" icon.
One way to avoid misrouted written correspondence is to send your inquiries to us electronically through myCGS! If you have general questions regarding appeals, claims processing, finance, medical review, provider enrollment, or provider outreach, we encourage you to send them via myCGS. Check here for a job aid to help you navigate this myCGS function.
For your convenience, we also offer a comprehensive list of Frequently Asked Questions (FAQs). To save yourself some time, check the FAQs first!
Below is a list of the top reasons providers write to us.
Top Written Inquiries: October 2020
Reason | Resource/Reference |
---|---|
Appeals: Duplicate |
The Interactive Voice Response (IVR)
Check the Appeals webpage for resources:
NOTE: Be sure to include authentication elements with your appeal requests! This includes:
|
General Information: Incomplete Information Provided |
When submitting inquiries, it is important that you include information needed to authenticate yourself, as this is a requirement of the Centers for Medicare & Medicaid Services (CMS). The data elements required to do this include:
If your inquiry is specific to a Medicare patient, the following beneficiary information also needs to be authenticated:
We cannot process inquiries submitted without these data elements. |
Financial Information: Electronic Funds Transfer (EFT) |
Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request, or revalidation, providers and suppliers that expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through electronic funds transfer (EFT). Section 1104 of the Affordable Care Act further expands Section 1862(a) of the Social Security Act by mandating federal payments to providers and suppliers only by electronic means. An Electronic Funds Transfer Authorization Agreement form To avoid delays with processing your enrollment applications, a voided check or bank letter MUST be submitted with the CMS-588 Electronic Funds Transfer Agreement to confirm your bank account information. |
Provider Enrollment: Not Classified |
When submitting inquiries, it is important that you include information needed to authenticate yourself, as this is a requirement of the Centers for Medicare & Medicaid Services (CMS). The data elements required to do this include:
Everything regarding credentialing is available to you on Provider Enrollment webpage!
|
Claim Denials: Medicare Secondary Payer (MSP) |
When Medicare is secondary, the primary payer must be billed first.
Need help determining the claim payment calculations? Check out the Medicare Secondary Payer Tool! |