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© 2011 Copyright, CGS Administrators, LLC.Revised June 14, 2011. 1 Kentucky Part B Providers.

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Presentation on theme: "© 2011 Copyright, CGS Administrators, LLC.Revised June 14, 2011. 1 Kentucky Part B Providers."— Presentation transcript:

1 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Kentucky Part B Providers

2 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Acquisition News BlueCross BlueShield of South Carolina has acquired CIGNA Government Services, LLC. While very little will change as a result of the acquisition, we have changed our name! As of June 1, 2011, we are legally known as CGS Administrators, LLC.

3 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Agenda J15 Transition Action Items KY Part B Operational Contacts Resources

4 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, J15 Kentucky Part B Action Items Electronic Funds Transfer Electronic Data Interchange J15 ListServ Local Coverage Determinations

5 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Electronic Funds Transfer (EFT) Have you received an EFT from CGS? CGS needs your Re-enrollment CMS 588 application to eliminate an interruption of your cash flow. The CMS 588 application can be found at: Need help completing the CMS 588 application, visit CGS EFT Web-based tutorial: https://www.cgsmedicare.com/captivate/J15588/CMS588Form. htm https://www.cgsmedicare.com/captivate/J15588/CMS588Form. htm

6 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Paper Checks If you received paper checks from NGS no additional steps are required. Once the claims have been on the payment floor, for the appropriate time, the paper checks will be issued to the Pay To address.

7 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, J15 Kentucky Electronic Data Interchange (EDI) CGS is subcontracting with National Government Services to continue to support the Kentucky Part B EDI workload on the current EDI Gateway. What does this mean for the Kentucky Part B provider community? There will be no change for your connectivity or transmission of EDI transactions for the J15 A/B MAC. Continue sending your claims and receiving your remittances to and from the same system.

8 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Effective April 30, 2011, through September 30, 2011, Kentucky Part B EDI Trading partners will continue to use the current National Government Services EDI Help Desk phone number, and option, When calling the Help Desk, there will be a selection specifically for the Kentucky Part B EDI trading partners. For EDI Enrollment activities, providers will continue to use the EDI Enrollment application available from the NGS website. J15 Kentucky Electronic Data Interchange (EDI)

9 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, J15 Kentucky Electronic Data Interchange (EDI) For 5010 testing/production implementation, Kentucky Part B trading partners will follow the NGS HIPAA 5010 Companion Guide. The Companion Guide will have specific references to J15, as applicable. For inquiries regarding 5010 testing, please use the Inquiry Form under 'Contact Us' on the NGS website:

10 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, J15 ListServ Our ListServ is the fastest and easiest way we can communicate news and information related to J15 transition activities. New Customers may register at:

11 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, J15 ListServ

12 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, J15 Local Coverage Determinations (LCDs) CGS has worked closely with NGS to identify and consolidate current LCDs. The LCDs are available on our website at: kyb/coverage/lcd/index.html kyb/coverage/lcd/index.html We strongly encourage you to closely review and familiar yourselves with all LCDs that will govern the types of services you provide.

13 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Kentucky Part B LCDs Remember, the effective date for CGS Kentucky Part B LCDs is April 30, Note: Services will be adjudicated based on their date of service. If CGS receives a claim with the date of service 02/13/2011, NGS LCDs would apply.

14 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, LCD Crosswalk In an effort to assist you in understanding the key differences between LCDs you are use to following and those that CGS currently use as of April 30, 2011, we have developed an LCD crosswalk. It is available here:

15 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, J15 Kentucky Part B Operational Contacts

16 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Interactive Voice Response (IVR) The Centers for Medicare & Medicaid Services (CMS) requires providers to utilize the Interactive Voice Response (IVR) System to check the status of claims. The IVR offers a host of self-service options, including claim status, patient eligibility, check status and more. Remember, CMS requires providers to use the IVR for these simple inquiries. KY Part B IVR: – The IVR is available 24 hours a day, 7 days a week, except for routine system maintenance – For inquires requiring access to the online system, the times below represent our online system availability: »Monday - Friday: 7:00am - 7:00 pm ET »Saturday: 7:00 am - 4:00 pm ET

17 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, J15 Part B User Guide

18 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, J15 Part B Provider Contact Center (PCC) For complex inquires that cannot be handled via the IVR and require the assistance of a Customer Service Representative, providers may call our Customer Service unit. Telephone Inquires: Customer Service is available: Monday - Friday: 8:00 am to 5:00 pm (ET) TTY/ TDD:

19 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, J15 Part B Provider Contact Center (PCC) There is a Three level Tier Process for the PCC Tier I: General inquires Tier 2: Escalated Inquires Tier 3: Complex Inquires (Handled by the Provider Relations Research Analyst) PRRS has up to 45 days to respond to inquires, verbal or written.

20 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Paper Claim Submission/General Correspondence For all general correspondence, including the submission of paper claims, please use the following mailing address: CGS 1 Cameron Hill Circle Suite 0060 Chattanooga, TN

21 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Appeals The first level of Appeals is Redeterminations. Send Redeterminations to: CGS 1 Cameron Hill Circle Suite 0061 Chattanooga, TN All Redeterminations must be received within 120 days of the initial determination.

22 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Reopenings Reopenings is a process used to correct minor errors or omissions to a previously processed claim without using the formal appeals process. A reopening must be requested within one year from the date of the initial determination.

23 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Reopenings Reopenings can be received via telephone, fax and/or written correspondence: Send the Written Reopening form to: – Address:CGS 1 Cameron Hill Circle Suite 0061 Chattanooga, TN – Telephone Reopenings: – Fax: – Web: reopenings.htmlhttp://www.cgsmedicare.com/kyb/forms/gateways/ reopenings.html

24 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Provider Enrollment Provider Enrollment primary responsibilities are credentialing and enrollment of Medicare Provider records. Telephone inquiries will be handled by the PCC at: Escalated inquires will be forwarded directly to the Provider Enrollment department. Provider Enrollment address: CGS 1 Cameron Hill Circle Suite 0062 Chattanooga, TN

25 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Overpayment Recovery Overpayment Recovery handles voluntary refunds, offsets, and lost checks Mailing Address for Refund checks: CGS J15 Part B Kentucky PO Box St. Louis, MO

26 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Resources

27 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, CMS Resources CMS provides numerous resources to assist providers! CMS website – Internet-Only Manual System – Medicare Coverage Data Base – Fee Schedules – MLN Matters Articles Open Door Forum Calls ListServ ( ) CMS Transmittals

28 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, CMS Website Take full advantage of Top 10 Links!!

29 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, MLN Matters Articles What are MLN Matters Articles? National Articles Helping Providers Understand New or Changed Medicare Policy User-friendly format Explain provider action needed

30 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, CGS Resources Provide a number of resources to assist you: CGS website – CGS Home – DME MAC Jurisdiction C – Home Health & Hospice – ID Part B Homepage – KY Part B Homepage – Ohio Part B Homepage Contact US ListServ Helpful Links

31 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, CGS Kentucky Part B Website

32 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, KY Part B Homepage Contains links to relevant information for Part B providers: Claims Processing Coverage & Pricing Education Provider Enrollment FAQs Forms News & Publications Tools & Site Map Customer Service

33 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Online Help Center Complex inquiries: Utilize for inquiries requiring research – Receive an response from subject matter experts – Response within 45 business days kyb/help/contact/onlinehelpJ15.html kyb/help/contact/onlinehelpJ15.html

34 © 2011 Copyright, CGS Administrators, LLC.Revised June 14, Questions?


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