CorporateBusiness Services

Kentucky and Ohio Part A Contact Information

Customer service:

  • Use CGS's free web portal, myCGS, for information on patient eligibility, claim status, certain types of financial information, submitting Redetermination requests (and supporting documentation) online, and downloading duplicate remittance advices (RAs).
  • Interactive Voice Response system (IVR): 866.289.6501
    • Note: You will be prompted for your PTAN, NPI and TIN.
    • Patient eligibility and claims status (6 a.m. to 6 p.m.) and other transactions are available 24/7
    • Access the IVR User Guide PDF
    • Order copies of the Standard Paper Remittance (SPR) (note: registered users of the myCGS portal may submit requests for duplicate remittance notices electronically)
  • To speak with a Customer Service Representative (CSR) (for information not available through the IVR), call: 866.590.6703 and select one of the following options. When Options 1 – 4 are selected, the Computer Telephony Integration (CTI) system will prompt you for information in order to validate your provider and beneficiary information. Be prepared and have the following information available before you call. Option 9 is only used for general questions not related to claim specific topics.
    • Your facilities National Provider Identifier (NPI); Provider Transaction Access Number (PTAN); the last 5 digits of the Provider Tax Identification Number (TIN)
    • Beneficiary’s Medicare health insurance claim (HIC) number; the beneficiary’s first name, last name, and date of birth.
      • Option 1 to reach a Part A CSR for assistance with Part A billing, claims, eligibility and payment.
      • Option 2 to reach an Electronic Data Interchange (EDI) Customer Service Representative for assistance with EDI enrollment, connectivity, PC-Ace Pro32, trading partners, and myCGS
      • Option 3 to reach a Part A CSR specializing in provider enrollment (PE) and can assist with inquiries about enrollment applications, enrollment revalidation, or electronic funds transfer enrollment.
      • Option 4 to reach a Part A CSR specializing in overpayment recovery (OPR) and can assist with inquiries related to financial inquiries such as refunds, offset, cost reporting, credit balance reporting, and extended repayment plans.
      • Option 9 to reach a Part A CSR for general questions. Refer to the “General or Claim Specific Questions When Calling the Provider Contact Center” article to determine if your question is considered a general question.
  • Telecommunications Devices for the Deaf (TTD/TTY): 855.294.9889
  • E-mail your question through our Online Help Center. Please note: do not send Protected Health Information (PHI) or Personally Identifiable Information (PII) through regular e-mail. This includes beneficiaries' Health Insurance Claim numbers (HICs).
  • Submit questions via regular mail to:

    CGS
    J15 Part A PCC
    PO Box 20200
    Nashville, TN 37202

Other specialized departments and associated contact information:

Department Contact Information

Appeals, including:

  • Requests for Redeterminations (first level appeals)
  • 935 Appeals related to Overpayments

Note: appeals must be filed within 120 days of the initial claim determination, with very few exceptions.

You must complete the first level of appeal before filing a subsequent level of appeal.

Registered users of the myCGS portal may submit Redetermination requests and supporting documentation electronically.

Access the Redetermination Request form here.

Mailing address:

CGS
J15 Part A Appeals
PO Box 20006
Nashville, TN 37202

Fed Ex/UPS/Certified Mail:
CGS
J15 Part A Appeals
2 Vantage Way
Nashville, TN 37228

935 appeals related to overpayments:
CGS
J15 Part A Overpayments Appeals
PO Box 20022
Nashville, TN 37202

Beneficiary Customer Service Center

(only Medicare beneficiaries should use this number)

1-800-MEDICARE (1-800-633-4227)
TTY: 877.486.2048

www.medicare.gov External Website

Claims

Mail hardcopy (UB-1450) claims to:
CGS
J15 Part A Claims
PO Box 20211
Nashville, TN 37202

Congressional Inquiries

For Inquiries from a Congressional Office

J15 - Part A/B Correspondence
CGS Administrators, LLC
PO Box 20018
Nashville, TN 37202

Fax: (615) 664.5923 (Preferred Method)

Cost Reports, including:

  • Checks related to cost reports

Cost Reports:
Regular Mail

J15 Part A Audit and Reimbursement
PO Box 20020
Nashville, TN 37202

FedEx/UPS/Overnight Courier:

CGS Administrators, LLC
J15 Audit and Reimbursement
Two Vantage Way
Nashville, TN 37228

Cost Report Overpayment Address (checks only):
Ohio providers:
CGS
Part A Ohio - Lockbox # 957635
1005 Convention Plaza
SL-MO-C1WS
St. Louis, MO 63101

Kentucky providers:
CGS
Part A KY - Lockbox # 957582
1005 Convention Plaza
SL-MO-C1WS
St. Louis, MO 63101

Credit Balance Reporting

Regular and Certified Mail:
CGS
Attn: J15 Credit Balance Reporting
PO Box 20023
Nashville, TN 37202

Fed Ex/UPS/Overnight Courier:
CGS
J15 Credit Balance Reporting
2 Vantage Way
Nashville, TN 37228

Reports may be faxed to:
MCBR Receipts
Attn: Credit Balance Reporting
Fax: 803.462.2584

To call with Inquiries, please dial 866.590.6703

Electronic Data Interchange (EDI), including:

  • EDI enrollment
  • Administrative Simplification and Compliance Act (ASCA)
  • Electronic Remittance Advice (ERA)
  • PC-ACE Pro 32 (billing software)
  • Direct Data Entry (billing software): enrollment, RACF IDs, problems with your claims being accepted (for other DDE questions, call 866.590.6703, option 1, to speak with a customer service representative)
  • Direct Data Entry (billing software): Password issues – call 615-660-5444 to speak with a security representative

J15 — Part A EDI
CGS Administrators, LLC
PO Box 20014
Nashville, TN 37202

EDI Help Desk: 866.590.6703 (choose option 2)

Investigational Device Exemption Requests

E-mail: J15IDE@cgsadmin.com

Medical Affairs

  • Medical Director

Neil S. Sandler, MD
Chief Medical Officer, J15 A/B MAC
CGS Administrators, LLC
Two Vantage Way
Nashville, TN 37228

Clinical questions should be submitted in writing to cmd.inquiry@cgsadmin.com or faxed to 615.664.5971.

All other questions should be directed to customer service who will forward your inquiry to the appropriate area.

Medical Review

  • Responding to Additional Documentation Requests (ADRs)
  • Responses to our requests for medical records

CGS
J15 Part A Medical Review
PO Box 20021
Nashville, TN 37202

FedEx/UPS/Overnight Courier:
CGS
J15 Part A Medical review
2 Vantage Way
Nashville, TN 37228

Fax: 803.462.2596

Medicare Secondary Payer (MSP): Benefits Coordination and Recovery Center (BCRC)

  • SE1416 explains situations and what actions the BCRC can take.

Telephone: 1-855-798-2627

Fax:
1-405-869-3307 (address the fax to Medicare- MSP General Correspondence)

Hours: Monday through Friday from 8 a.m. to 8 p.m. ET, except holidays.

Mailing address:

Medicare – MSP General Correspondence
P.O. Box 138897
Oklahoma City, OK 73113-8897

Overpayments

  • Overpayments
  • Checks for cost report and credit balances
  • Immediate offset requests

Checks:
CGS - J15 Part A Kentucky
PO Box 957582
St. Louis, MO 63195-7582

CGS - J15 Part A Ohio
PO Box 957635
St. Louis, MO 63195-7635

Extended Repayment Schedules

Provider Inquiries:
For telephone assistance regarding overpayments, please call the Provider Contact Center at 866.590.6703

To request an immediate offset, fax your request, including this form PDF, to 615.664.5932.

Provider Audit, including issues related to:

  • Questions about cost reports, desk reviews, audits and settlements
  • Filing cost report appeals and reopenings

Provider Audit:
Regular Mail

J15 Part A Audit and Reimbursement
PO Box 20020
Nashville, TN 37202

FedEx/UPS/Overnight Courier:

CGS Administrators, LLC
J15 Audit and Reimbursement
Two Vantage Way
Nashville, TN 37228

Appeals and Reopenings:
Regular Mail

J15 Part A Audit and Reimbursement
PO Box 20020
Nashville, TN 37202

FedEx/UPS/Overnight Courier:

CGS Administrators, LLC
J15 Audit and Reimbursement
Two Vantage Way
Nashville, TN 37228

E-mail address for filing cost report appeals: J15.CR.Appeals@CGSAdmin.com

E-mail address for filing cost report reopenings: J15.CR.Reopening@CGSAdmin.com

Provider Enrollment

  • General Enrollment questions
  • Initial Enrollment and Change of Ownership questions
  • Change address, add a location
  • Electronic Funds Transfer (EFT) CMS 588 form
  • How to obtain a National Provider Identifier (NPI)

CGS
J15 Part A Provider Enrollment
PO Box 20004
Nashville, TN 37202

For telephone assistance, please call the Provider Contact Center at 866.590.6703

Access Internet-based PECOS External Website(note: your facility's Authorized Official must register first)

Obtain electronic CMS 855 application forms External Website

Provider Outreach and Education (POE)

  • Request education or training
  • Request a speaker for association meetings in your state

CGS
J15 Part A POE
P.O. Box 20200
Nashville, TN 37202

Email your request to J15_PartA_Education@cgsadmin.com.

Provider Reimbursement

  • Interim rate information
  • Reimbursement issues
  • Reimbursement specialist
  • Submission of certificates

Regular Mail:

J15 Part A Audit and Reimbursement
PO Box 20020
Nashville, TN 37202

FedEx/UPS/Overnight Courier:

CGS Administrators, LLC
J15 Audit and Reimbursement
Two Vantage Way
Nashville, TN 37228

Phone: 803.763.5554

E-mail: J15.Reimbursement@CGSAdmin.com

Quality Improvement Organization (QIO) - Ohio

  • Quality of care concerns regarding Medicare beneficiaries
  • Quality Improvement Plans
  • Electronic Health Records (EHR) and Meaningful Use of Technology

Ohio KePro
Rick Run Center
Suite 100
5700 Lombardo Center Drive
Seven Hills, OH 44131

800.385.5080

www.ohiokepro.com External Website

Quality Improvement Organization (QIO)- Kentucky

  • Quality of care concerns regarding Medicare beneficiaries
  • Quality Improvement Plans

Health Care Excel of Kentucky, Incorporated
1941 Bishop Lane
Suite 400
Louisville, KY 40218

502.454.5112

www.hce.org External Website

Qualified Independent Contractor (QIC) Part A West Jurisdiction (KY and OH)

  • Second-Level Appeals (Reconsiderations)

Maximus Federal Services
3750 Monroe Ave
Part A West – Suite 706
Pittsford, NY 14534

QIC Part A West Standard Reconsiderations:  585.348.3020
QIC Part A West Expedited Reconsiderations:  585.348.3040

http://www.medicarepartaappeals.comExternal Website

Reopenings

Access the Clerical Error Reopening Form here.

CGS
J15 Part A Claims
PO Box 20211
Nashville, TN 37202

Zone Program Integrity Contractor (ZPIC)

  • Suspected fraud
  • Potential abuse
  • Questionable billing practices

Cahaba Safeguard Administrators, LLC
375 Riverchase Parkway East
Birmingham, AL 35244

http://cahabasafeguard.com/ External Website

Feedback to the Centers for Medicare & Medicaid Services (CMS)

If you would like to send any feedback to CMS regarding your experiences with CGS, please direct your comments to:

POE Coordinator for KY
CMS Region IV
61 Forsyth Street, S.W., Suite 4T20
Atlanta, GA 30303-8909

POE Coordinator for OH
CMS Region V
233 N. Michigan Avenue
Suite 600 Chicago, IL 60601

Contracting Officer's Representative

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

Margot Warren, CPA
Medicare Contractor Management Group
J15 Contracting Officer's Representative
Centers for Medicare & Medicaid Services
1961 Stout St. Rm 08-148
Denver, CO 80294

J15 Project Officer

Melissa Lamb
J15 Project Officer
CGS Administrators, LLC
Two Vantage Way
Nashville, TN 37228

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Updated: 07.1.16


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