- Which Resource Should You Use?
- Before You Call…
- Three Levels of Customer Service
- Hours of Operation
- Written Correspondence
- Additional Resources
- Online Claim Status Inquiry & Beneficiary Eligibility
Jurisdiction C DME MAC offers several different tools to assist DMEPOS suppliers. The Interactive Voice Response (IVR) system is available to answer a variety of your inquiries, including claim status, beneficiary eligibility, redetermination status, financial information, and more. You may also check claim status and beneficiary eligibility online through the CSI/BE system. For information not available on the IVR or the CSI/BE system, you may contact our Provider Customer Service hotline. Customer Service Representatives (CSRs) are available to assist suppliers Monday through Friday from 7:00am to 5:00pm CST.
In addition to telephone services, suppliers may also send written inquiries to the DME MAC Written Correspondence team at the following address:
PO Box 20010
Nashville, TN 37202
Medicare beneficiaries and their representatives should contact 1.800.MEDICARE (1.800.633.4227) for all of their questions about Medicare. 1.800.MEDICARE is available to assist beneficiaries 24 hours a day, 7 days a week. For questions specific to DME MAC, beneficiaries should ask for "Medical Supplies" or visit the Medicare Web site.
Which Resource Should You Use?
The fastest way to check claim status and beneficiary eligibility is through the CSI/BE system. If you are not currently signed up for CSI/BE, you can find instructions for signing up, as well as a user guide for CSI/BE, on our CSI/BE page.
If you are not signed up for CSI/BE, you may check claim status and beneficiary eligibility using the IVR. The IVR is also available to provide additional information that is not available through CSI/BE. Below is a list of the information which you can find on the IVR:
For information which cannot be found on the IVR or through the CSI/BE system, suppliers may contact our Customer Service hotline.
Customer Service Representatives are able to:
- Clarify the denial reason associated with a claim
- Provide general information regarding Medicare coverage
- Explain terminology and information published in issues of the DME MAC Insider and the Supplier Manual
- Assist with other complex issues
Customer Service Representatives are not able to:
- Provide claim status, beneficiary eligibility, or other information which is available through the IVR
- Give preauthorization of beneficiary entitlement for specific DME
- Adjust a claim, unless the claim was processed incorrectly by the contractor (please call Telephone Reopenings at 866.813.7878)
- Answer questions about supplier enrollment (please call the National Supplier Clearinghouse at 866.238.9652)
- Answer questions about electronic billing software or claims that have not been received in our claim processing system (please call CEDI at 866.311.9184)
- Answer inquiries from beneficiaries or their representatives (please call 1.800.MEDICARE – 800.633.4227)
Before You Call…
Before calling a Customer Service Representative, you should take the following steps:
- Consult your Medicare Remittance Notice (MRN)
- Consult the Denial Guide on the CGS website
- For medical necessity and coverage issues, consult the appropriate Local Coverage Determination (LCD)
- For general questions about DME MAC, consult the Jurisdiction C Supplier Manual
When calling Customer Service, please be sure to have the following information ready to give to the CSR:
- Your NPI number
- Your Provider Transaction Access Number (PTAN), also known as your Legacy number or NSC number
- The last five numbers of your Tax Identification Number (TIN)
- Beneficiary's HICN, name, date of service, and/or date of birth (if appropriate)
Three Levels of Customer Service
When calling Customer Service, you will initially speak to a Tier 1 CSR. Tier 1 CSRs are capable of handling most supplier inquiries. In some cases, Tier 1 CSRs may need to transfer the call to a Tier 2 CSR (also known as the Help Desk). If a callback is required, a Tier 2 CSR will return your call within 10 business days.
If you have a complex inquiry that goes above and beyond the normal scope of a Tier 1 or Tier 2 CSR, the inquiry will be forwarded to the third level of Customer Service, the Provider Relations Research Specialist (PRRS) team. The PRRS will research the inquiry and respond either by phone or by mail within 45 business days.
Customer Service Hours of Operation
Customer Service Representatives (CSRs) are available to assist suppliers Monday through Friday from 7:00am to 5:00pm CST.
CSRs will not be available on the following holidays:
Please note that the contact center is closed for staff training on the first Thursday of every month from 8:30 am to 12:30 pm Central Time (except for weeks in which there is a federal holiday closing). The contact center may also close to observe other Federal holidays. A ListServ message will be sent out informing you of additional closings or changes in availability. If you are not signed up to receive Listserv notifications, please sign up here.
Suppliers may submit written inquiries to the DME MAC via mail, fax (615.782.4624), or email. When writing, please state your question or concern as clearly as possible including all pertinent information, i.e., NPI number, PTAN, and, if appropriate, the beneficiary's name, HICN, and date of service (note that email inquiries must not contain sensitive personal information). This will allow us to respond more specifically to the inquiry. You must also include your name and phone number. After the correspondence is received by the DME MAC, a Written Correspondent will respond to the inquiry within 45 business days.