Part B - Ohio

CGS Administrators, LLC provides a variety of services for Medicare beneficiaries, health care providers, and medical equipment suppliers in 33 states supporting the needs of over 16 million Medicare beneficiaries nationwide.

As a Medicare Part A, Part B, Home Health and Hospice, and Durable Medical Equipment contractor for the Centers for Medicare & Medicaid Services, we process and pay Medicare claims according to the Congressional Laws and CMS rules and regulations. We do not determine who is eligible for Medicare.

CGS Administrators, LLC currently provides Part A Medicare claims processing and customer support services in the states of: Kentucky and Ohio. CGS also provides services for Home Health and Hospice in the states of Colorado, Delaware, DC, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, N Dakota, S Dakota, Pennsylvania, Utah, Virginia, West Virginia, and Wyoming. In addition we provide services for Medicare Part B for the states of: Ohio and Kentucky, and we provide service to Durable Medical Equipment suppliers in the states of: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia.

myCGS

• myCGS Login
• Introducing myCGS
• Checklists
• FAQs
• The Benefits of myCGS
• User Manual
• Help Desk Information/Contact

Claims Processing

This section has important information about filing claims to the A/B MAC. Most Medicare providers are required to bill claims electronically (rather than paper) in accordance with the Administrative Simplification Compliance Act (ASCA).

General Claims Resources

How to submit Part B claims. Here you'll find claims resources, help with common claim submission errors, the IVR system, and more!

Comprehensive Error Rate Testing (CERT)

The Centers for Medicare & Medicaid Services (CMS) developed the Comprehensive Error Rate Testing (CERT) program to produce national, contractor-specific, and service-specific paid claim error rates. Find CERT information and resources here.

Electronic Data Interchange (EDI)

Looking for EDI information? Learn about MREP, crossover claims, how to get started billing electronically, and much more.

ICD-10-CM/PCS

The Centers for Medicare & Medicaid Services (CMS) website provides a dedicated ICD-10 web page which offers a variety of resources to assist providers with the ICD-10 implementation. Here are just some of the resources available on the CMS ICD-10 website.

Top 5 Denials and Resolutions

Often within claims processing, we notice trends and patterns among the filed claims regarding denials from provider services. The five listed are consistently at the top of the list. These files will give further information about the denial, as well as the easiest way to resolve those issues.

Five Levels in the Appeals Process

Take a detailed look at redeterminations, requesting a reconsideration, Administrative Law Judge hearings, Appeals Council review, and Judicial Review in U.S. District Court.

Primary Care Incentive Program (PCIP) Tool

For primary care services furnished on or after January 1, 2011 and before January 1, 2016, a 10 percent incentive payment will be provided to primary care practitioners. CMS has provided CGS Administrators, LLC with a list of the National Provider Identifiers (NPIs) of the primary care practitioners eligible to receive the incentive payments. Use this tool to find out if you are eligible to participate in the Primary Care Incentive Program.

Medicare Timely Filing Guidelines

CMS-1500/ Electronic Claim Crosswalk

Electronic Data Interchange (EDI)

• 5010 Institutional and Professional Edits Spreadsheet
• 5010 Part B Companion Guide
• 5010 Trading Partner Directory
• Articles and Updates
• Version 5010: How Health Care Providers Can Ensure a Smooth Transition
• Crossover Claims Resources
• Communications Testing Application
• EDI Enrollment Packet
• MCS Edits
• Medicare Fee-For-Service Standard Companion Guide Trading Partner Information
• Medicare Remit Easy Print (MREP)
• Frequently Asked Questions (FAQs)
• Get Started Billing Electronically
• Glossary
• Job Aids
• PC-Ace Pro32 Software
• Products and Services
• Report Request Tool
• Technical Support
• EDI Archive

Ohio Part B Coverage & Pricing

Medical Review

What is Medical Review? What are the types of contractors we work with to achieve the goal of reducing improper payments?

Medical Director Contact Information

Mailing and telephone information for your Ohio Part B Medical Director.

Fee Schedules

The Part B Physician Fee Schedule, Physician Fee Schedule Relative Value Units, ZIP Code Files, and more.

Local Coverage Determinations (LCDs)

Review active LCDs and Policy Articles, as well as draft articles and the LCD Reconsideration Process.

Self-Administered Drugs

Process to Determine Which Drugs Are Not Usually Self-Administered by the Patient and SAD List

Ohio Part B Events & Education

ACT (Ask the Contractor Teleconferences)

This is your opportunity to ask questions regarding Medicare issues that impact your company and receive answers from Part B subject matter experts.

Online Education Center

Don't have time to attend a workshop or sit in on a Webinar? Our Online Education Center allows you to choose from a variety of courses and to explore them at your own pace.

Video Education

Our video education modules provide targeted information on a variety of Medicare topics. CGS is committed to providing the most current and relevant educational material for our Fee for Service Providers (FFS).

Ohio Education Page

This section includes the Calendar of Events, and Workshop and Webinar Listings for Ohio.

Our primary source of educational materials comes from the Medicare Learning Network.

For comprehensive educational materials and tools, visit the Medicare Learning Network (MLN). These materials have been designed to promote the CMS goal of providing Up-to-date educational information to Medicare providers that accompany the release of new or revised Medicare program policies.

As a result of changes in policy and legislation, Medicare providers may be uncertain as to what Medicare policy changes have occurred and how those changes apply to them. The MLN provides a variety of training and educational materials that break down Medicare policy into plain language. The MLN delivers planned and coordinated provider education through the various mechanisms such as National Educational Articles, Brochures, Fact Sheets, Web-Based Training Courses, Videos and Podcasts.

Ohio Part B Provider Enrollment

Provider/Supplier enrollment is a critical function that attempts to ensure that only qualified and eligible individuals and entities are enrolled in the Medicare Program and receive reimbursement for services furnished to beneficiaries.

Provider Enrollment Quick Links

• Checking the Status of Your Application
• Enrollment Applications
• Enrollment Package
• Important Information About the Enrollment Process
• Independent Diagnostic Testing Facility Performance Standards and Approved Codes
• Internet-based PECOS
• MEDPARD (Medicare Participating Physicians/Suppliers Database)
• National Provider Identifier (NPI)
• Opting Out of Medicare
• Provider Enrollment Information: Guidance for Completing the Enrollment Forms
• Program Integrity Manual
• Report of Ohio Providers Opted Out of Medicare - Updated: 04.01.13
• Revalidation
• Telephone Numbers

FAQs

CMS FAQs

By selecting this option you will be taken to the CMS website.

Part B FAQs

Choose from a variety of topics, including Coordination of Benefits, Electronic Data Interchange, Medicare Secondary Payer, and more. You'll also find a complete listing of past FAQs on a variety of topics, including Overpayment Recovery, Medical Review and more.

Part B Forms

Welcome to the Part B forms section. As forms are identified and updated for Part B, we will post them to this section.

The forms offered below are in Adobe PDF format. Download a free copy of Acrobat Reader.

General Part B

• All CMS Forms
• IDE Request Requirements
• Immediate Offset Request Form
• Overpayment Refund
• Progressive Corrective Action Form
• Publications Order Form
• PWK Fax/Mail Cover Sheet
• Overpayment Recovery Form

Appeals

• Five Levels in the Appeals Process
• Redetermination Request Form

Extended Repayment Plan (ERP)

• Extended Repayment Plan (ERP)

Reopenings

• Reopenings Adjustment Request Form

Provider Enrollment

• Enrollment Applications
• Authorization Agreement For Electronic Funds Transfer
• Participation Agreement

Electronic Data Interchange

• PWK Fax/Mail Cover Sheet

All EDI forms and correspondence must be submitted to the address and/or fax number below for processing. This includes forms for new setups as well as forms for changes to existing setups. Failure to send the forms to the correct address will result in the application being returned to you.

Ohio Part B News & Publications

News

Important and timely articles and information for the current month.

Fee Schedules

The Part B Physician Fee Schedule, Ambulatory Surgical Center Fee Schedule database, Physician Fee Schedule Relative Value Units, ZIP Code Files, and more.

Medicare Bulletin

The Medicare Bulletin contains important information that will assist the provider community in day to day operations. It includes information published during the previous quarter by the Centers of Medicare and Medicaid Services (CMS) and by CGS

Medicare Incentives Program Job Aid

The Medicare Incentives Job Aid is a document that breaks down the various incentives CMS offers as part of the Medicare Program. Included are PQRS, HPSA, Primary Care Incentive, and more!

Medicare Resources Manual

An overview or the Medicare Program, including the Medicare Appeals Process, Provider Enrollment, Web Tools, and more.

Medicare Advisory

The Medicare Advisory was a periodical produced by Palmetto GBA. For your convenience, we have made the last few years of this publication available.

Specialty Manuals

The specialty-specific coverage and billing guidelines are available through these PDF files. Any changes, additions, or modifications to these manuals will be posted to the CGS Web site and in the Medicare Bulletin.

EDI Connection

The EDI Connection has been developed especially for software vendors. The EDI Connection, together with occasional special releases, serves as legal notice to vendors concerning the responsibilities and requirements imposed upon them by Medicare law, regulations and guidelines.

Medicare Tools & Site Map

Site Map

Need help finding your way around our site? This resource will help.

Join the Listserv

By joining the CGS electronic mailing list, you can get immediate updates on all Medicare information, including: Medicare publications, important updates, workshops, and medical review information

Update or Delete Your ListServ Profile

Update your contact information, contract preferences and more, or unsubscribe from the CGS electronic mailing list.

Bilateral Services Job Aid

The bilateral services job aid has been designed to help educate our provider community on the research and billing of bilateral services. This job aid has specific references and step-by-step instructions on accessing the Medicare Physician Fee Schedule Database to find bilateral indicators.

CERT Claim Identifier Tool

This CERT Claim Identifier Tool has been designed to aid Medicare providers obtain the results of their CERT review. You may search this database by CID or Medicare/Provider Number.

NEW! Helpful Links and Bookmarks

This document contains the top website links and bookmarks that will be beneficial to your office. All the information will be at your fingertips!

Medicare Secondary Payer (MSP) Job Aid

The Medicare Secondary Payer (MSP) Job Aid has been designed to aid Medicare providers in ensuring the correct coordination of benefits for their patients. With specific directions for billing conditional payment, various insurance types, and required documentation, this will assist with all your MSP needs!

Modifier Finder Tool

This Modifier Finder tool has been designed to aid Medicare providers in using modifiers correctly. You may search this database by modifier or keyword. All records matching your search criteria will be returned for your review. Or, if you wish, you may also view the entire listing of modifiers, their definitions, and additional billing information.

Primary Care Incentive Program (PCIP) Tool

For primary care services furnished on or after January 1, 2011 and before January 1, 2016, a 10 percent incentive payment will be provided to primary care practitioners. CMS has provided CGS with a list of the National Provider Identifiers (NPIs) of the primary care practitioners eligible to receive the incentive payments. Use this tool to find out if you are eligible to participate in the Primary Care Incentive Program.

Skilled Nursing Facility (SNF) Consolidated Billing (CB) Job Aid

The Skilled Nursing Facility (SNF) Consolidated Billing Job Aid to aid providers in the determination of payable services under Part B if the patient is in a SNF. This job aid gives directions on referencing the CMS website for information, appropriate modifiers, and more!

Customer Service

Contact Customer Service

Which customer service resource should you use? What should you do before you call? What are our hours of operation?

Contact Other CGS Departments/Resources

Including Appeals, Claim Reopenings, Provider Enrollment, Written Inquiries, and more.

Contracting Officer's Representative

Should you wish to offer comment to CMS concerning CGS' performance, please write to the address below:

Steven A. Smetak
Contracting Officer's Representative (COR) for the J15 A/B MAC
Western MAC Program Management Division 
Medicare Contractor Management Group
Centers for Medicare & Medicaid Services
1600 Broadway, Suite 700
Denver, CO  80202

Interactive Voice Response (IVR) System

The IVR offers a host of self-service options, including claim status, patient eligibility, check status, offset information, and more. Remember, CMS requires providers to use the IVR for these simple inquiries.

1-866-290-4036

The IVR is available 24 hours a day, 7 days a week, except for routine system maintenance. However, the most common IVR inquiries also require the IVR to access our online system. The times below represent our online system availability, which means that all IVR options are routinely available during these times:

Monday - Friday: 7:00am - 7:00 pm ET
Saturday: 7:00 am - 4:00 pm ET

Online Help Center

The Online Help Center allows you to submit inquires electronically to our customer service staff. It is important to note that you should not submit inquiries or comments through this system that contain sensitive personal information (i.e., social security numbers, tax I.D. numbers, beneficiary numbers, claim information, etc.) as this method of submitting an inquiry is unsecured and unencrypted. In addition, also note that our customer service staff has 45 days in which to respond to your electronic inquiry.

Website Feedback

The purpose of the Website Feedback form is for you to provide your comments about the CGS website, or to make our website admin aware of any technical issues you may experience with the site. Our site admin can not assist you with general or specific Medicare questions.

Helpful Links

Here you'll find information about the Competitive Bidding process, the Medicare Contractor Provider Satisfaction Survey (MCPSS), links to other contractors, and important CMS links.