Introducing CGS Connect™ for Jurisdiction B! Our unique concierge-level service offers Jurisdiction B suppliers the opportunity to receive professional review and evaluation of pre-claim documentation before submitting an initial claim to Medicare.
CGS Connect™ is a voluntary program that provides you with a higher level of assurance that your supporting documentation meets the necessary requirements to process your claim for payment consideration.
CGS Connect™ is not a prior approval or authorization program. Participation in CGS Connect™ does not exempt suppliers from the audit process. Our review and recommendations under the CGS Connect™ program are for educational purposes only and do not guarantee payment for services billed. CGS Connect™ does offer you professional evaluation of your pre-claim documentation and it provides you with individualized education to prevent future documentation-related errors.
Here's How It Works:
As a Jurisdiction B supplier, you may request a non-clinical (DCR) or a clinical (Complex) review of your pre-claim documentation.
- DCR reviews are currently limited to the following HCPS Codes. To view the Local Coverage Determination (LCD) for each HCPCS, please click on the following link:
- Clinical reviews of medical records are currently limited to Urological Supplies (A4353), PAP (E0601), Oxygen and Oxygen Equipment (E1390), Manual Wheelchairs (K0004), Hospital Beds and Accessories (E0260/E0394/E0301/E0303/E0912)
When you request a clinical review through CGS Connect™, our professional Medical Review clinicians will evaluate your documentation using their applied medical knowledge of policy-based requirements. When necessary, the clinician will contact you directly to discuss their evaluation and recommendations. You will then have the opportunity to correct the errors in the documentation (if possible) and submit the claim for processing.
When you request a non-clinical review through CGS Connect™, our professional review staff will review your documentation and provide you with documented, detailed feedback via a letter on any issues or concerns identified during the review. CGS allows one additional CGS Connect™ request to review documentation after you have had the opportunity to make improvements before you submit your claim.
When Can You Expect A Response?
If the documentation review is being requested after the equipment has been delivered, CGS will respond in writing within 15 days. You will be notified that the documentation is either "supported" or "unsupported" and you will be provided with information about why the documentation didn't meet Medicare guidelines.
If the documentation review is being requested before the equipment has been delivered, CGS will attempt to respond with a phone call and a letter within 10 days.
And, if you get an answer with the first request that your documentation is "unsupported" but you want to collect more and have us look at it again, you'll get an answer within 30 days. Please ensure that all supporting documentation is submitted with your second request.
Our CGS Connect™ program offers a broad range of benefits, including:
- A reduction in claim denials related to documentation errors
- A reduced need to appeal claim payment decisions
- One-on-one education on the correct way to submit required documentation
How Do You Get Started?
To request a professional pre-claim review of your documentation, simply complete the CGS Connect™ Request Form located under the "forms" section of CGSMedicare.com. CGS Connect™ Request Form instructions and important fax information is included with the form.