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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 5 Written Inquiries: June 2020

Reason Resource/Reference

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:

  • Your National Provider Identifier (NPI);
  • Your Provider Transaction Access Number (PTAN);
    • Be sure to use the Group PTAN (when applicable). Individual PTANs are not used in the privacy verification process when a Group PTAN is assigned to the provider.
  • The last 5-digits of your tax identification number (TIN).

If your inquiry is specific to a Medicare patient, the following beneficiary information also needs to be authenticated:

  • The patient's Medicare ID
    • Either the Medicare Beneficiary Identifier (MBI) or the Health Insurance Claim Number (HICN)
  • First initial
  • Last name (first 6 letters); and
  • Date of birth

We cannot process inquiries submitted without these data elements.

Appeals: Duplicate

The Interactive Voice Response (IVR)PDF is a resource available to you to check the status of Redeterminations.

Check the Appeals webpage for resources:

  • Appeals Timeliness Calculator
  • Help determining what form the use
  • Link to Redeterminations form

NOTE: Be sure to include authentication elements with your appeal requests! This includes:

  • Your National Provider Identifier (NPI);
  • Your Provider Transaction Access Number (PTAN);
    • Be sure to use the Group PTAN (when applicable). Individual PTANs are not used in the privacy verification process when a Group PTAN is assigned to the provider.
  • The last 5-digits of your tax identification number (TIN).

Return-to-Provider (RTP): Contractual Obligation (CO) Not Met

Services rejected or denied with a Contractual Obligation (CO) group code may not be billed to the patient.

Rely on the CGS web site search engine to locate articles to address a number of issues

Adjustments: Not Classified

When claims are processed (either paid or denied) and you discover errors or omissions, you may request a Part B Reopening. This includes modifiers, billed amount, place of service, and CPT/HCPCS codes

  • The most efficient way to submit Reopenings is through myCGS
    • Reopenings job aids are available to help navigate step-by-step instructions
    • Completed correctly, your Reopening may process in a few as six days
    • A submission ID is assigned to your Reopenings, allowing you to track its status
  • You may also submit hardcopy Reopenings

On occasion, mass adjustments are done, which require no action from you

Claim Denials: Duplicate

Duplicate claims must be avoided:

  • Check the status of ALL claims before resubmitting
    • Use myCGS to check the status of claims
    • The Interactive Voice Response (IVR) is another option
      • Select option to check for additional claims with same date of service to locate the claim originally paid
  • Submit multiple same services provided on same date on ONE claim
  • Use appropriate modifier to avoid duplicate denials (e.g., 50, RT, LT)
  • When resubmitting services initially rejected (message code MA130), DO NOT include services that were previously paid

For example: A claim is submitted with three line items. Two of the services are paid; one is rejected because the CPT code was invalid. When resubmitting a new claim with the corrected CPT code, do not include the two services previously paid, as they will deny as duplicate.

Claim Denials: Coding Errors/Modifiers

Call center staff cannot choose modifiers for you, as they do not have access to your medical records to ensure correct documentation is present

  • Utilize the Modifier Finder Tool for help with correctly selecting and using modifiers
  • Please be sure the documentation in the patient's medical record supports the use of any modifier added to a claim
  • For additional information, view the recorded webinar, "Avoid Modifier Rejections!External Website" to learn more about the most commonly used modifiers

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