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November 6, 2018 - Revised: 01.29.19

myCGS Claim Status Enhancements

The Claims tab in myCGS allows users to check the status of patient claims that have been submitted to CGS; submit Part B claims to us electronicallyPDF; and review a listing of the Part B claims submitted through myCGS that did not pass our front-end edits.

The claim status function has been enhanced to allow you to perform a number of additional functions directly from the Claim Status page! 

The enhancements include:

  • Submit a Redetermination (1st level appeal)
  • Request a Part B Reopening of the claim (correct minor errors or omissions)
  • Respond to a request for additional documentation
  • View CARC and RARC Codes and definitions
  • Ask questions regarding the claim

To access claim information, you must complete the Claim Status Inquiry page.

  • Select the Claims tab. The Claim Status Inquiry page will display.
  • Enter the patient’s Medicare ID
  • Enter a date range in a MM/DD/CCYY format.

    NOTE:  Retrieving claims information older than 6 months may take additional time. In addition, offline claims will not be displayed. Many claims are offline after 3 years, sometimes earlier.

  • Click Submit

    Screen Shot

If there are claims in the date range you entered, a listing of claims will display. Each claim will have a link to the claim details. Select the Claim # to view the Detailed Claims Status Information page.

Screen Shot

The header of the Detailed Claims Status Information page provides information specific to the claim.  You will also see a letter icon in the ‘ADR Letter’ field if the claim is pending response to a request for additional documentation.  Also, the ‘Diagnosis’ field will display the primary diagnosis submitted on the claim.

Screen Shot

The line item details are noted directly below the header information, which includes:

  • HCPCS/CPT codes
  • Service dates
  • Billed and allowed amounts
  • Non-covered charges
  • CARC and RARC codes on completed claims only (if available)

    Screen Shot

Depending upon the status of the claim, the date of service and/or the date the claim was processed, you may perform a number of functions:

  • If the claim is pending due to a request for additional documentation from either our Claims or Medical Review departments, selecting the ‘Submit Documents’ button. 
    • This allows you to attach documentation and respond to the request directly through myCGS.
  • Request a Part B Reopening
  • Submit a RedeterminationPDF (1st level appeal)
  • Send a request to receive the remittance advicePDF
  • Check the eligibility of the patientPDF for which the claim was submitted
  • Ask a Question regarding the claim

Screen Shot

For your convenience, when you select one of the functions noted above, most of the required fields on the form will auto-populate with information from the claim and specific to your user ID.

NOTE:  Options not available for the claim displayed will be grayed out.  Grayed options could also indicate you do not have authorization to perform that function.  Check with your provider administrator for access.

You may also click ‘Back’ to return to the claim list. 

No Claims Data Appears
If no claims are displayed for the date period you have chosen, you may want to choose a different date range or double-check your records to make sure you have entered the correct patient Medicare ID. Claims that are paid, in process, returned, or denied are displayed. Information is retrieved from CMS standard systems and is as current as the standard systems. Claims that are offline or returned without processing will not appear.

Take advantage of this enhancement and a number of additional myCGS functions available to you. 

Not currently using myCGS?  Register TODAY!

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