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Part B Interactive Voice Response System

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ATTENTION: Please be aware that providers will need their billing NPI, PTAN and the last five digits of their tax identification number in order to utilize the IVR or when speaking to a Customer Service Representative.

You may access our IVR by calling the following toll-free telephone number:

Part B providers: 1.866.290.4036

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 is available during and outside normal customer service hours with allowances for system maintenance and mainframe availability. Your NPI and PTAN are needed to obtain information from the IVR or a Customer Service Representative. You can also order duplicate remittance notices, as well as obtain the Medicare Part B deductible status, eligibility, Medicare Secondary Payer information, allowable for procedure codes, denial reasons, outstanding check amounts, NPI and PTAN validation and other claim processing information.

When a claim has completed processing and is being held due to the payment floor, you will not be able to obtain claim detail until the remittance is issued. If you have a business need to receive this information before the remittance is issued, you may want to consider Claim Status Inquiry. Contact the EDI department at 866-276-9558.

CGS requires providers to use the IVR for simple transactions, such as eligibility, deductible, Medicare Secondary Payer, claims status and outstanding check information. This allows our Customer Service Staff to be available when you need dedicated assistance for your complex issues. For callers, if your inquiry cannot be resolved through the IVR, you may reach a customer service representative by calling 1.866.276.9558.

Steps in Using the Interactive Voice Response (IVR) System

Greeting

"You have reached the Interactive Voice Response Access line for CGS Medicare Part B. To ensure excellent customer service, your call may be monitored or recorded for evaluation purposes."

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Main Menu

  • Press "1" for claim status
  • Press "2" for eligibility, deductible and therapy limitation information
  • Press "3" for financial information
  • Press "4" for other inquiries
  • Press "5" for NPI and PTAN crosswalk validation & to verify NPI in PECOS
  • Press "6" for general information
  • Press "7" to repeat information
  • Press "0" for the customer service representative phone number

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National Provider Identifier (NPI)

Enter your NPI followed by the "#" key

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Provider Transaction Access Number (PTAN)

Providers will follow the prompts below:

If you PTAN begins with one or more letters, press "1", otherwise press "2"

After pressing "1":

After pressing "1":

  • Your PTAN consists of a letter-number combination. Enter the first letter.
  • If your PTAN has a second letter press "1", otherwise press two.
  • If your PTAN has a third letter press "1", otherwise press two.
  • Now enter the numbers followed by the "#" key.

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Tax Identification Number

Enter the last 5 digits of your tax identification number followed by the "#" key.

Please note the NPI, PTAN and last 5 digits of the tax identification number must be a valid combination on the crosswalk in order to obtain information.

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Entering PTAN letters

To enter a letter, you will press two keys:

  • First, press the key with the letter.
  • Then press "1", "2", or "3" depending upon the position of the letter on that key.
  • Example: To enter the letter A, press "2" then "1"
    On telephones where Q appears with P, R, and S on key 7 assume that R and S are the second and third positions respectively. Regardless of your telephone type, assume that Q and Z are on the one key. Q would be positioned as the first letter and Z as the second.
    • Example: To enter Z, press "1" then "2".
  • Enter PTAN letters:
     
    A 21
    B 22
    C 23
    D 31
    E 32
    F 33
    G 41
    H 42
    I 43
    J 51
    K 52
    L 53
    M 61
    N 62
    O 63
    P 71
    Q 11
    R 72
    S 73
    T 81
    U 82
    V 83
    W 91
    X 92
    Y 93
    Z 12

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Patient's Medicare Number

  • Press "1" if the Medicare number ends in a letter or letter-number combination.
  • Press "2" if the Medicare number begins with one or more letters.
  • Enter the first 9 digits of the Medicare number.
  • If the letter at the end of the Medicare number is:
     
    A press "1"
    B press "2"
    C press "3"
    D press "4"
    M press "5"
    T press "6"
    W press "7"
    Any other letter press "0" for the customer service representative phone number.
  • If there is a number after the letter, press that number now.
  • If there is nothing following the letter, press "#" pound key.
  • If there is another letter following the letter, press "*" star key.
  • If the second letter is:
     
    A press "1"
    B press "2"
  • If it is any other letter, press "0" for the customer service representative phone number.

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Patient's Name

  • Enter the beneficiary's first initial using the letters on your telephone keypad.
  • Enter the first six digits of the beneficiary's last name followed by the # key.
  • Example 1: Smith will be "7", "6", "4", "8". "4".
  • Example 2: Smith Jr will be "7", "6", "4", "8", "4" "5"

**Hint** Only enter letters. Ignore any spaces and enter the first 6 letters.

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Claim and Redetermination Status

Enter the date of service for this claim. Enter the date in a month-month, day-day, year-year format.

Example: If the date of service is January 25, 2000, enter "0", "1", "2", "5", "0", "0". Enter the date now.

Press"1" for claim status
Press"2" for redetermination status

Claim status

NOTE: The system will give claim information in the following categories:

  • Claim pending
  • Applied to deductible
  • Paid
  • Denied

– The system only advises payment made to the provider.

– Non-assigned paid claim information will not be given.

  • Press "1" for line-by-line information, otherwise press "2" to continue.

    After pressing "1" and line information is given for the first line, press "1" for the next line and for each line until you receive the message there are no more lines for this claim.

  • Press "1" for a duplicate remit, otherwise press "2".

After claim information and/or line-by-line information:

  • Press "1" to check another claim with the same date of service.
  • Press "2" to check for a claim with a different date of service.
  • Press "3" to check on a claim for a different HICN.
  • Press "7" to repeat the claim information
  • Press "9" to get information about a different NPI.

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Redetermination Status

You will receive the following information for the provider and patient information entered:

  • Date of receipt for the redtermination
  • Pending for requests that are not completed
  • Completion date
  • Decision (upheld or reversed) for most redetermination requests

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Eligibility Information

  • Enter the beneficiary's 8 digit date of birth. Enter the date in a month-month, day-day, century-century, year-year format. (Example: November 01, 1933 enter "1", "1. "0". "1". "1". "9", "3", "3")
  • Press "1" for eligibility information.
  • Message: "The most current records we have on file from the Social Security Administration show this beneficiary has Medicare Part A entitlement effective… and Part B entitlement effective…"
  • To verify if this beneficiary is enrolled in a Medicare Advantage Plan, press "1".

    You will receive one of the following messages:

    1. "According to our records there is no Medicare Advantage Plan information available for the Medicare Number you entered."
    2. "The most current records we have on file show this beneficiary is currently enrolled in a Medicare Advantage Plan beginning…."
  • Medicare Advantage Plan DirectoryExternal Website
  • To verify Medicare Secondary Payer information for this beneficiary effective today, press "2".
    • You have chosen to check MSP information. The information given is the most current on record. Please note we will only verify disability, working aged and ESRD records and that the beneficiary is the best source for current MSP information. You will receive one of the following messages:

      "Our records show Medicare is primary for this beneficiary."

      "Our records show Medicare may be secondary to another insurer. For more information contact the beneficiary. When Medicare may be secondary you will also receive the MSP type (for Disability, Working aged and ESRD only)."

  • To verify Medicare Secondary Payer information for this beneficiary for a specified date, press "3".
    • You will be prompted to enter your date.

      You have chosen to check MSP information. The information given is the most current on record. Please note we will only verify disability, working aged and ESRD records and that the beneficiary is the best source for current MSP information. You will receive one of the following messages:

      "Our records show Medicare is primary for this beneficiary."

      "Our records show Medicare may be secondary to another insurer. For more information contact the beneficiary. When Medicare may be secondary you will also receive the MSP type (for Disability, Working aged and ESRD only)."

  • To verify Home Health and Hospice information, press 4.
    • You have chosen to check Home Health and Hospice information for this beneficiary. The most recent Home Health and Hospice episode dates will be given.

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Deductible and Therapy Limitation Information

  • Enter the beneficiary's 8 digit date of birth. Enter the date in a month-month, day-day, century-century, year-year format. (Example: November 01, 1933 enter "1", "1. "0". "1". "1". "9", "3", "3")
  • Press "2" for deductible.
  • Message:

    "The amount of deductible applied for the current calendar year is XX dollar(s) and XX cent(s)."

    After the current year deductible you may press "2" for the previous year applied deductible.

  • Press "3" for the physical therapy limitation.
  • Message:

    "The amount of physical therapy limitation applied for the current calendar year is XX dollar(s) and XX cent(s).

  • Press "4" for the occupational therapy limitation.
  • Message:

    The amount of occupational therapy limitation applied for the current calendar year is XX dollar(s) and XX cent(s).

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Financial Information (Outstanding Checks, Pending Claim Totals and Offset Information)

**Note** Pending claims totals are for assigned claims only.

  • Press "1" for outstanding checks released to your NPI within the last month.
  • After receiving information on the first outstanding check, press "1" for the next outstanding check.
  • Press "1" to repeat all check information until you receive the message there are no more outstanding checks.
  • Press "2" for the total assigned claims that are in approved to pay status and are awaiting the payment floor.
  • Press "3" for the total other assigned claims pending.
  • Press"4" for offset information "You will be prompted to enter the FCN from your provider remittance advice"

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Other Inquiries

  • Press "1" for an allowable
  • Press "2" to order a duplicate remittance notice

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Allowable Information

  • Press "1" if the procedure code begins with a letter.
  • Press "2" for all other procedure codes.
  • If the type of service is a number, press "1".
  • If it is a letter, press "2".
  • Enter the type of service.
  • Enter the zip code. (Note this is the 5 digit zip code.)
  • Message: "The current year allowed amount for this procedure code is _________."

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Procedure Codes that Begin With a Letter

  • If the procedure begins with the letter:
     
    A press "1"
    G press "2"
    J press "3"
    M press "4"
    Q press "5"
    R press "6"
    V press "7"
    E press "8"
    B press "9"
    D press "#"
  • Now enter the 4 numbers that follow the prefix.

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Procedure Code Modifier and Type of Service

  • Press "1" if there is a modifier at the end of the procedure code.
  • Press "2" for no modifier.
    • Press 1 for an alpha modifier
    • Press 2 for a numeric modifier

    NOTE: Modifier:

    AH press "1"
    AJ press "2"
    AS press "3"
    TC press "4"
    26 press "5"
    54 press "6"
    55 press "7"
    80 press "8"
    78 press "9"
  • Now enter the type of service
    • Press "1" if it numeric
    • Press "2" if it is a letter
  • Message: "The current year allowed amount for this procedure code is _________. "

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NPI and PTAN Crosswalk Validation

If you have made change to the NPPES system within the last 5-10 business days please note that those changes may not yet be reflected in our system.

Enter your billing NPI.

Enter your billing PTAN.

You will receive one of the following messages:

  • Yes, your NPI and PTAN are currently on the crosswalk in our system.
  • No, your NPI and PTAN are not currently linked in our system. Please visit the NPPES website, https://nppes.cms.hhs.govExternal Website and make sure that the NPI and PTAN are linked. If they are linked there, but are not cross walked in our system, please contact a Provider Customer Service Representative at 1.866.276.9558.

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NPI in PECOS Verification

This option will verify your individual NPI in PECOS.

  • Enter your individual NPI.
  • Enter your individual PTAN
  • Enter the last 5 digists of your tax identification number.

You will receive one of the following messages:

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General Information

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.
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

Provider Enrollment Correspondence

1-866-276-9558
CGS
PO Box 20017
Nashville, TN 37202

Paper Claims Submission

CGS
PO Box 20019
Nashville, TN 37202

General Correspondence/Appeals

CGS
PO Box 20018
Nashville, TN 37202

Provider Outreach and Education

Provider Enrollment

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Constant Prompts throughout the IVR

The following prompts are constant throughout the IVR:

  • Press "7" to repeat information.
  • Press "8" to return to the main menu.
  • Press "9" for information on a different NPI.

Example: Checking status of a claim for a provider with a letter at the end to the PTAN.
PTAN 11111D, Medicare number 111111111A, date of service 010303

  • Press "1" - claim status.
  • Enter your NPI followed by the # key.
  • Press "1" - PTAN ending with a letter.
  • Press "11111# " - the numeric portion of the PTAN followed by #.
  • Press "3", then "1" - if the letter is a D, press "2" for no second letter.
  • Listen to NPI repeated.
  • Press "1" if the PTAN is correct.
  • Press "1" for a Medicare number that ends in a letter or a letter-number combination.
  • Press "111111111" - the numeric portion of the Medicare number.
  • Press "1" - if the letter at the end of the Medicare number is an A.
  • Enter the patient's first initial.
  • Enter the first 6 digits of the patient's last name.
  • Press "010303" - for the date of service.

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Updated: 02.28.13


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