© 2011 copyright, cgs administrators, llc.revised june 14, 2011. 1 kentucky part b providers
TRANSCRIPT
Revised June 14, 2011.
1
© 2011 Copyright, CGS Administrators, LLC.
Kentucky Part B Providers
Revised June 14, 2011.
2
© 2011 Copyright, CGS Administrators, LLC.
Acquisition NewsAcquisition 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.
Revised June 14, 2011.
3
© 2011 Copyright, CGS Administrators, LLC.
AgendaAgenda
J15 Transition Action Items
KY Part B Operational Contacts
Resources
Revised June 14, 2011.
4
© 2011 Copyright, CGS Administrators, LLC.
J15 Kentucky Part B Action ItemsJ15 Kentucky Part B Action Items
Electronic Funds Transfer
Electronic Data Interchange
J15 ListServ
Local Coverage Determinations
Revised June 14, 2011.
5
© 2011 Copyright, CGS Administrators, LLC.
Electronic Funds Transfer (EFT)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: http://www.cms.gov/cmsforms/downloads/CMS588.pdf
Need help completing the CMS 588 application, visit CGS’ EFT Web-based tutorial: https://www.cgsmedicare.com/captivate/J15588/CMS588Form.htm
Revised June 14, 2011.
6
© 2011 Copyright, CGS Administrators, LLC.
Paper ChecksPaper 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.
Revised June 14, 2011.
7
© 2011 Copyright, CGS Administrators, LLC.
J15 Kentucky J15 Kentucky Electronic Data Interchange (EDI)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.
Revised June 14, 2011.
8
© 2011 Copyright, CGS Administrators, LLC.
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, 1.877.273.4334 and email option, [email protected].
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 J15 Kentucky Electronic Data Interchange (EDI)Electronic Data Interchange (EDI)
Revised June 14, 2011.
9
© 2011 Copyright, CGS Administrators, LLC.
J15 Kentucky J15 Kentucky Electronic Data Interchange (EDI)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 Email Inquiry Form under 'Contact Us' on the NGS website: http://www.ngsmedicare.com.
Revised June 14, 2011.
10
© 2011 Copyright, CGS Administrators, LLC.
J15 ListServJ15 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: http://www.cgsmedicare.com/medicare_dynamic/ls/001.asp
Revised June 14, 2011.
11
© 2011 Copyright, CGS Administrators, LLC.
http://www.cgsmedicare.com/medicare_dynamic/ls/001.asp
J15 ListServJ15 ListServ
Revised June 14, 2011.
12
© 2011 Copyright, CGS Administrators, LLC.
J15 Local Coverage J15 Local Coverage Determinations (LCDs)Determinations (LCDs)
• CGS has worked closely with NGS to identify and consolidate current LCDs.
• The LCDs are available on our website at: http://www.cgsmedicare.com/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.
Revised June 14, 2011.
13
© 2011 Copyright, CGS Administrators, LLC.
Kentucky Part B LCDsKentucky Part B LCDs
Remember, the effective date for CGS Kentucky Part B LCDs is April 30, 2011.
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.
Revised June 14, 2011.
14
© 2011 Copyright, CGS Administrators, LLC.
LCD CrosswalkLCD 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: http://www.cgsmedicare.com/j15/LCDCrossWalk.xls
Revised June 14, 2011.
15
© 2011 Copyright, CGS Administrators, LLC.
J15 Kentucky Part B J15 Kentucky Part B Operational ContactsOperational Contacts
Revised June 14, 2011.
16
© 2011 Copyright, CGS Administrators, LLC.
Interactive Voice Response (IVR)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: 1.866.290.4036
– 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
Revised June 14, 2011.
17
© 2011 Copyright, CGS Administrators, LLC.
J15 Part B User GuideJ15 Part B User Guide
http://www.cgsmedicare.com/kyb/claims/ivr/PartB_IVR_user_guide.pdf
Revised June 14, 2011.
18
© 2011 Copyright, CGS Administrators, LLC.
J15 Part B Provider Contact Center (PCC)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: 1.866.276.9558
Customer Service is available: • Monday - Friday: 8:00 am to 5:00 pm (ET)
• TTY/ TDD: 1.888.270.9481
Revised June 14, 2011.
19
© 2011 Copyright, CGS Administrators, LLC.
J15 Part B Provider Contact Center (PCC)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.
Revised June 14, 2011.
20
© 2011 Copyright, CGS Administrators, LLC.
Paper Claim Paper Claim Submission/General CorrespondenceSubmission/General Correspondence
For all general correspondence, including the submission of paper claims, please use the following mailing address:
CGS1 Cameron Hill Circle Suite 0060Chattanooga, TN 37402-0060
Revised June 14, 2011.
21
© 2011 Copyright, CGS Administrators, LLC.
AppealsAppeals
The first level of Appeals is Redeterminations. Send Redeterminations to:
CGS1 Cameron Hill Circle Suite 0061Chattanooga, TN 37402-0061
All Redeterminations must be received within 120 days of the initial determination.
Revised June 14, 2011.
22
© 2011 Copyright, CGS Administrators, LLC.
ReopeningsReopenings
“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.
Revised June 14, 2011.
23
© 2011 Copyright, CGS Administrators, LLC.
ReopeningsReopenings
Reopenings can be received via telephone, fax and/or written correspondence: • Send the Written Reopening form to:
– Address: CGS1 Cameron Hill CircleSuite 0061 Chattanooga, TN 37402-0061
– Telephone Reopenings: 1.855.273.7616
– Fax: 1.615.664.5914
– Web: http://www.cgsmedicare.com/kyb/forms/gateways/reopenings.html
Revised June 14, 2011.
24
© 2011 Copyright, CGS Administrators, LLC.
Provider EnrollmentProvider Enrollment
Provider Enrollment primary responsibilities are credentialing and enrollment of Medicare Provider records.• Telephone inquiries will be handled by the PCC at: 1.866.276.9558.
Escalated inquires will be forwarded directly to the Provider Enrollment department.
Provider Enrollment address:CGS1 Cameron Hill CircleSuite 0062 Chattanooga, TN 37402-0062
Revised June 14, 2011.
25
© 2011 Copyright, CGS Administrators, LLC.
Overpayment RecoveryOverpayment Recovery
Overpayment Recovery handles voluntary refunds, offsets, and lost checks
Mailing Address for Refund checks: CGS J15 Part B Kentucky PO Box 957065 St. Louis, MO 63195-7065
Revised June 14, 2011.
26
© 2011 Copyright, CGS Administrators, LLC.
ResourcesResources
Revised June 14, 2011.
27
© 2011 Copyright, CGS Administrators, LLC.
CMS ResourcesCMS 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 (Email)
• CMS Transmittals
Revised June 14, 2011.
28
© 2011 Copyright, CGS Administrators, LLC.
CMS WebsiteCMS Website
http://www.cms.gov/ • Take full advantage of Top 10 Links!!
Revised June 14, 2011.
29
© 2011 Copyright, CGS Administrators, LLC.
MLN Matters ArticlesMLN Matters Articles
http://www.cms.gov/MLNMattersArticles/
What are MLN Matters Articles?• National Articles Helping Providers Understand New
or Changed Medicare Policy
• User-friendly format
• Explain provider action needed
Revised June 14, 2011.
30
© 2011 Copyright, CGS Administrators, LLC.
CGS ResourcesCGS 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
Revised June 14, 2011.
31
© 2011 Copyright, CGS Administrators, LLC.
CGS CGS Kentucky Part B WebsiteKentucky Part B Website
http://www.cgsmedicare.com/kyb/index.html
Revised June 14, 2011.
32
© 2011 Copyright, CGS Administrators, LLC.
KY Part B HomepageKY 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
Revised June 14, 2011.
33
© 2011 Copyright, CGS Administrators, LLC.
Online Help CenterOnline Help Center
Complex inquiries:• Utilize for inquiries
requiring research
– Receive an email response from subject matter experts
– Response within 45 business days
http://www.cgsmedicare.com/kyb/help/contact/onlinehelpJ15.html
Revised June 14, 2011.
34
© 2011 Copyright, CGS Administrators, LLC.
Questions?Questions?