Chapter 1 – Overview

What is FISS?

The Fiscal Intermediary Standard System (FISS) is the standard Medicare Part A claims processing system. Through its Direct Data Entry (DDE) system you may perform the following functions:

• Enter, correct, adjust, or cancel your Medicare billing transactions
• Inquire about beneficiary eligibility
• Inquire about the status of claims
• Inquire about the need to respond to an additional development request (ADR)
• Access various inquiry screens (e.g., revenue codes, diagnosis codes, reason codes, etc.)

FISS Availability

FISS is available Monday through Friday typically between the hours of 5:00 a.m. and 8:00 p.m. CT (Central Time) and Saturday between the hours of 5:00 a.m. and 5:00 p.m. CT. Note: Depending on the time it takes the nightly system cycle to run, FISS may not always be available at 5:00 a.m. CT. In addition, FISS system releases may affect availability over weekends. FISS is not available on Sunday or on national holidays.

Direct Access to FISS

If you want direct electronic access to FISS in order to perform the above functions, contact the CGS EDI (Electronic Data Interchange) department between 7:00 a.m. – 4:00 p.m. CT (8:00 a.m. 5:00 p.m. ET). For Home Health and Hospice providers, dial 1.877.299.4500 (select Option 2), or for Part A providers, dial 1.866.590.6703 (select Option 2) for assistance. You must also contract with a connectivity vendor to establish direct connection to the Enterprise Data Center (EDC) for FISS access through a connectivity product (e.g., IVANS or VisionShare). The CGS EDI department does not provide support for your connectivity product; therefore, you will need to contact your connectivity vendor for any issues related to your direct connection.

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Sign-on/Sign-off Procedures

Once connection has been established, the CGS EDI department will provide the necessary logon-ID and password. If you experience any security issues with accessing FISS or need to have your password reset, please email the CGS Security Administration Team at cgs.medicare.opid@cgsadmin.com or you may call them at 1.615.660.5444. Please include the user ID that is experiencing problems and the first and last name of the user to which that ID is assigned in your email request.

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CMS DXC Virtual Data Center

To access FISS DDE, type 2 in the Enter Request field on the DXC Virtual Data Center screen and press the ENTER key. The DXC–VDC Menu screen will display.

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DXC-VDC Sign-on Menu

1. Type your logon-ID in the Userid: field.
2. Tab to the Password: field and type your password.
3. Press the ENTER key.
   
   

   The TPX MENU FOR <logon-id> screen will display. Your cursor will be positioned in the Command ===> field in the lower left corner.

   
4. Use your Tab key to move your cursor to the left of the MAC J15 FISS PROD – HHH application line (for Part A providers HHH is replaced with PART A). Type an S and Press the ENTER key.

   The Welcome to CMS screen will appear as shown below. The cursor will be positioned in the upper left corner of the screen. type FSS0 (the 0 is the number zero; not the letter 'O') to access the FISS Main Menu.

   

   Your connection through the Enterprise Data Center (EDC) may allow you to access the beneficiary eligibility information via the Common Working File (CWF) Part A Eligibility System screens, ELGA (Part A eligibility information) and ELGH (Home Health/Hospice eligibility information). To check beneficiary eligibility information via CWF records, instead of typing FSS0, type ELGA to access ELGA, or type ELGH to access ELGH. Press ENTER.

   When accessing ELGA or ELGH, you will be prompted to enter beneficiary information. Refer to the Checking Beneficiary Eligibility in this User Manual for additional information.

   Beginning fall of 2019, CMS discontinued clearinghouse and vendor access to the CWF beneficiary eligibility data when they already access this same data through the HIPAA Eligibility Transaction System (HETS). Providers can continue to submit individual provider queries using the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Beneficiary/CWF (Option 10). Refer to the Inquiry Menu in this User Manual for additional information.

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Terminating the Session

Follow the steps below when you are finished with FISS.

1. When you are finished in FISS, press F4 to terminate your session. When you are finished in ELGA or ELGH press F3 to exit.
2. Type logoff and press ENTER. The TPX MENU FOR <logon-id> screen will display.
3. Your cursor will be positioned in the Command ===> field in the lower left corner. type /K and press the ENTER key.

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Accessing Multiple Sessions

With direct connection, you have the ability to access multiple sessions simultaneously. This means that you can be signed on to FISS and to ELGA or ELGH at the same time. To learn how to access more than one session, refer to the instructions provided by your connectivity vendor.

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FISS Menu Options

The FISS Main Menu contains four options (listed below). Additional instructions, screen illustrations and field descriptions of each option are included in this User Manual.

All the FISS functionality that you will need for claims processing is available through FISS options 01, 02, and 03.

The CWF Part A Eligibility System screens, ELGA (Part A eligibility information) and ELGH (Home Health/Hospice eligibility information) are accessible through the FISS connection; however, they are not accessible within the FISS menu options. Refer to the Checking Beneficiary Eligibility in this User Manual for additional information.

The following provides screen prints of the FISS DDE menu options 01 (Inquiry), 02, (Claim/Attachments), and 03 (Claims Correction) and a summary of how providers can utilize these menu options.

All FISS direct data entry (DDE) screens display two lines of information in the top right corner that identifies the region (ACPFA052), the current date, release number (e.g., C20112VF) and the time of day. This information will assist CGS staff in researching issues when screen prints are provided.

All FISS screens are referenced by Map numbers. Map numbers (e.g., MAP1701) are listed in the upper left corner of the screen. Each claim screen displays page numbers to the right of the Map number.

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Inquiry Menu

The Inquiry Menu allows you to check the status of claims, including how to check for Additional Development Requests (ADRs), claims summary, Medicare check history, payment totals, view inquiry screens to check the validity of diagnosis codes, revenue codes, HCPCS codes, and review reason code narratives.

The menu options shown in bold text are those that you will use most often. For additional details, refer to the Inquiry Menu section of this User Manual.

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Claim and Attachments Entry Menu

The Claim and Attachments Entry Menu allows you to enter UB-04 claim information, including home health requests for anticipated payment (RAPs), hospices notices of election (NOEs), notices of election termination/revocation (NOTRs) and roster bill data entry for influenza vaccines and pneumococcal vaccines provided by approved facilities. For additional details, refer to Claims and Attachments Menu section in this User Manual.

The "Attachment Entry" options are not accepted electronically via FISS DDE.

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Claims and Attachments Correction Menu

The Claims and Attachments Correction Menu allows you to correct billing transactions that are in the Return to Provider (RTP) file, adjust and cancel billing transactions.

The menu options shown in bold text are those that you will use most often. For additional details refer to the Claims Correction section in this User Manual.

The "Attachments" options are not accepted electronically via FISS DDE.

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FISS Shortcuts

• Use your arrow keys and/or Tab key to move between fields. Do not use your ENTER key or the space bar. Using the Tab key is preferred, as your arrow keys may not place your cursor in the correct field position.
• If you attempt to type in an invalid field position, your keyboard will lock. To "unlock" your keyboard, try to press the ESC key or the left Ctrl key. The method used to unlock your keyboard depends on your keyboard set up. Once you have unlocked your keyboard, you must press the Tab key to move your cursor into a valid field position.
• To move back one data field at a time, press and hold the SHIFT key and then press Tab.
• To quickly move between claim pages, press your HOME key on your keyboard, which takes your cursor to the 'Page' field. Type the number of the page to which you want to move, and then press Enter. In FISS, the claim consists of six pages. However, two additional pages, page 7 and page 8, are available for claims in Additional Development Request (ADR) status/location S B6001.
• While in a claim, use the SC (Screen Control) field located in the upper left corner (under the Page field) of the FISS screen as a shortcut to information within the Inquiry Menu. To access this field, press the HOME key and then the Tab key. To quickly move to one of the following options, type the option number (e.g., 13) in the 'SC' field and press Enter. Press F3 to return to the claim page. Refer to the following example.
  
  

  10	Beneficiary/CWF	16	Adjustment Reason Codes
  13	Revenue Codes	17	Reason Codes
  14	HCPC Codes	56	Claim Count Summary
  15	Diagnosis/Procedure Codes	68	ANSI Reason Codes

  Example: To move from the Claim Entry screen to the revenue code screen, type 13 in the SC field and press ENTER. The Revenue Code Table Inquiry screen appears.

  

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FISS Function Keys

The use of the function keys described below allows you to move within the FISS screens. FISS displays what function keys are available for use on the bottom of each screen. Function keys are most often found across the top of your keyboard.

F1	Help	From a claims entry, inquiry, or correction screen, F1 provides a narrative description of a reason code that appears on a billing transaction (used most often in the return to provider (RTP) file).
F2	Line Item Detail Info	Enables user to access line item detail information for a particular revenue code line in FISS from page 02 of the claim.
F3	Screen Exit	Exits user to previous screens.
F4	System Exit	Terminates FISS session and returns user to blank screen where 'FSS0', 'ELGA', 'ELGH', or 'Logoff' can be entered.
F5	Scroll Back	Scrolls up (backward) through a list of revenue code page.
F6	Scroll Forward	Scrolls down (forward) through a list or revenue code page.
F7	Page Back	Moves user one FISS claim page back.
F8	Page Forward	Moves user one FISS claim page forward.
F9	Save	Saves/stores claim information. (Note: FISS will only save information when the information is complete and correct.)
F10	Scroll Left	Scrolls one page to the left. Only available on the following screens: MAP171A, MAP171E, MAP171D, MAP 1719, MAP1772 Also retrieves claim data for an archived claim.
F11	Scroll Right	Scrolls one page to the right. Only available on the following screens: MAP1712, MAP1713, MAP171A, MAP171E and MAP1771

Use caution before pressing F3 because it will take you back to the previous screen and could cause you to lose your work. For example, if you are entering a billing transaction into FISS and accidentally press F3, you will be returned to the Claim and Attachments Entry Menu and the information you were entering on the billing transaction will be lost.

You may need to contact your connectivity vendor for assistance in mapping your keyboard if your function keys do not achieve the same results as described above.

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FISS Shortcuts

• Use your arrow keys and/or Tab key to move between fields. Do not use your ENTER key or the space bar. Using the Tab key is preferred, as your arrow keys may not place your cursor in the correct field position.
• If you attempt to type in an invalid field position, your keyboard will lock.  To "unlock" your keyboard, try to press the ESC key or the left Ctrl key. The method used to unlock your keyboard depends on your keyboard set up. Once you have unlocked your keyboard, you must press the Tab key to move your cursor into a valid field position.
• To move back one data field at a time, press and hold the SHIFT key and then press Tab.
• To quickly move between claim pages, press your HOME key on your keyboard, which takes your cursor to the 'Page' field. Type the number of the page to which you want to move, and then press Enter. In FISS, the claim consists of six pages. However, two additional pages, page 7 and page 8, are available for claims in Additional Development Request (ADR) status/location S B6001.
• While in a claim, use the SC (Screen Control) field located in the upper left corner (under the Page field) of the FISS screen as a shortcut to information within the Inquiry Menu. To access this field, press the HOME key and then the Tab key. To quickly move to one of the following options, type the option number (e.g., 13) in the 'SC' field and press Enter. Press F3 to return to the claim page. Refer to the following example.
  
  

  10	Beneficiary/CWF	16	Adjustment Reason Codes
  13	Revenue Codes	17	Reason Codes
  14	HCPC Codes	56	Claim Count Summary
  15	Diagnosis/Procedure Codes	68	ANSI Reason Codes

  Example: To move from the Claim Entry screen to the revenue code screen, type 13 in the SC field and press ENTER. The Revenue Code Table Inquiry screen appears.

  

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FISS Screen Prints

To print a copy of an FISS screen, try one of the following options:

• Select File from the Toolbar and click on Print from the dropdown box
• Press ALT+PRINT SCREEN
• Press SHIFT+PRINT SCREEN
• Press ALT+L

If you are unable to print using the options above, try pressing the PRINT SCREEN key on your keyboard, which will make a copy of the screen; then open a word processing software document and paste the copied image into it. You should then be able to print the word processing document. If none of these options work, and you have consulted with your technical support department with no resolution, please contact your connectivity vendor.

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Monitoring Your Billing Transactions

CGS recommends that you use FISS to check your billing transactions at least once a week. Checking more often is encouraged. For some billing transactions, you may need to take additional action after you have submitted them. There are often provider deadlines associated with these additional actions. For example, when responding to an additional development request (ADR) (status/location S B6001), documentation must be received by CGS within 45 calendar.

Some claims may be returned to the provider (RTPd) due to missing, incorrect, or incomplete information. You will need to access your billing transactions in the Return to Provider (RTP) to make the necessary corrections. When a claim is corrected from the RTP file, it will receive a new receipt date.

To assist you with monitoring your billing transactions, CGS has developed the following checklist. When you sign on to FISS, you should:

• Check option 56 (Claim Count Summary) within the "Inquiry Menu" to see a quick summary of billing transactions that are currently processing in FISS. Refer to the Inquiry Menu section of this User Manual for information about the Claim Count Summary screen.
• Correct any billing transactions that are in your RTP file. Refer to Claims Correction" section of this User Manual for additional information.
• Respond to any ADR. Refer to the Inquiry Menu section of this User Manual for information about accessing ADRs.

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About Status/Location Codes

As billing transactions process in FISS, they move through various stages of the system. These stages are identified by status/location codes and provide information about what's happening to the billing transaction. Sometimes the status/location indicates that you need to take action on the billing transaction in order for it to continue processing. There are six status codes that are represented in FISS by one letter (e.g., P for Paid). By looking at the status, you can quickly find what's happening to your billing transaction. Review the table below to familiarize yourself with these codes. This table will be a valuable resource when reviewing the Claim Count Summary (56) screen.

Claim Status	Which Means?
P (Processed/Paid)	Claim is approved for payment and is on the payment floor. This is also considered to be a finalized status.
R (Rejected)	Billing transaction is rejected for reasons such as: Medicare eligibility issue Billing issues Duplicate to a previously submitted claim
D (Denied)	Claim is denied by medical review or claim was submitted as a demand denial.
S (Suspended)	Billing transaction is temporarily paused in FISS for processing and/or Medicare staff intervention may be required. No action is required by you unless the claim is in status/location S B6001 (Additional Development Request (ADR)). Billing transactions may be suspended for about 30 days. Claims that have been selected for an ADR or for medical review may be suspended for more than 30 days. Claims with Medicare Secondary Payer (MSP) information often require Medicare staff intervention and may be suspended for more than 60 days.
T (Return to Provider [RTP])	Billing transaction is waiting for correction by you in the RTP file.
I (Inactivated)	Billing transaction was inactivated or suppressed from RTP. Awaiting final system purge.

Locations further define what is happening to a billing transaction in a particular status. Locations are 5-character positions that follow the status code (e.g., P B9997; where P is the status and B9997 is the location). There are thousands of combinations of status/locations and not all are represented in this guide. Because of the quantity, CGS does not provide a printed handout of all the possible status/location code combinations. However, we do provide you with the most common status/location codes listed below.

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Common Status/Location Codes

P B9996	Payment floor
P B9997	Processed or paid (full or partial) billing transaction
P B7501	Post-pay MSP review
P B7505	Post-pay MSP review
P O9998	Archived claim
R B9997	Rejected billing transaction (finalized)
R B75XX	Rejected billing transaction (suspended). It may take at least 75 days for the claim to move to R B9997 finalized status/location.
D B9997	Denied claim (all services denied). Claims with partial denials will appear in the P status.
T B9900	Billing transaction will need correction when it moves into T B9997 in next cycle.
T B9997	Billing transaction needing correction by provider (referred to as the Return to Provider (RTP) status/location).
S B0100	System processing (billing transaction is suspended).
S B6000	Claim will need additional information when it moves to S B6001.
S B6001	Claim needs additional information from provider (often referred to as ADR, MR ADR (medical review Additional Development Request) or non-MR ADR).
S M50MR	Medical review of documentation (claims move to this location once ADR information has been received). This review process may take up to 60 days to complete.
S M5CLM	After the ADR documentation has been reviewed by the Medical Review department, the claim is moved to S M5CLM for additional processing.
S B90XX	Claim data is being compared with beneficiary eligibility information posted at the Common Working File (CWF).
S MXXXX	Suspended claim/adjustment requires Medicare staff intervention and may be suspended for about 30 days. Claims with Medicare Secondary Payer (MSP) information may be suspended for more than 60 days. Providers may call the Provider Contact Center if their claims have been in the same "S M XXXX " status/location for longer than 30 days, or 60 days for MSP claims.
S M87DR	Hospice Only – acknowledgement that CGS has received the documentation for an exception request for an untimely notice of election. Refer to the "Requesting an Exception for an Untimely NOE" Web page for additional information.
S M87RE	Hospice Only – the documentation provided in the Remarks field for an exception request for an untimely notice of election is being reviewed.
S M8877	Hospice Only – if documentation for an exception request for an untimely notice of election is not received within 30 days of the initial request, the claim will move to this status/location until day 45, or until your documentation is received. If documentation is not received by day 46, the claim will be released to process as billed. Refer to the "Requesting an Exception for an Untimely NOE" Web page for additional information.
S MRADJ	MSP adjustment – created after MSP adjustment received; awaiting completion.
I B9900	Billing transaction inactivated from RTP file; waiting to purge from FISS.

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Chapter 2 – Checking Beneficiary Eligibility

Checking Beneficiary Eligibility Using ELGA or ELGH

Providers are encouraged to check the beneficiary's Medicare eligibility often. Eligibility should be checked at least prior to admission, monthly and prior to submitting billing transactions for processing. Checking beneficiary eligibility allows you to identify critical information such as whether the beneficiary is/has:

• Entitled to Medicare Part A, Part B, or both Part A and Part B
• Enrolled in a Medicare Advantage (MA) plan
• Enrolled with another insurance that is primary over Medicare
• In an open 60-day HH PPS (Home Health Prospective Payment System) episode
• A prior/current hospice election period
• Met their deductible requirements
• Met the therapy cap for the calendar year

Eligibility records, which are maintained for CMS (Centers for Medicare & Medicaid Services) by the Social Security Administration, are stored electronically in the CWF (Common Working File) system. You can access CWF records to view eligibility information via the eligibility screens, ELGA (Part A eligibility) or ELGH (home health and hospice eligibility) provided that you have identifying information about your beneficiary.

Home health and hospice providers will normally access ELGH. ELGA is typically used by hospitals and skilled nursing facilities (SNFs). However, it may be necessary to use both ELGH and ELGA to obtain all the necessary eligibility information for a beneficiary depending upon the services being billed to Medicare.

NOTE: Beginning fall of 2019, CMS discontinued clearinghouse and vendor access to the CWF beneficiary eligibility data when they already access this same data through the HIPAA Eligibility Transaction System (HETS). Providers can continue to submit individual provider queries using the FISS DDE Beneficiary/CWF (Option 10). Refer to Inquiry Menu section of this User Manual for additional information.

Information Necessary to Check Eligibility

You must have the following five pieces of information about the beneficiary to check eligibility:

1. MBI (Medicare Beneficiary Identifier) Number (also called their Medicare number)
2. First initial of first name
3. Last name
   • If the beneficiary's name is John Smith Jr., enter "SMITHJR"
4. Date of birth (MMDDCCYY format)
5. Gender

Note: Beginning January 1, 2020, you must use the MBI to access eligibility information. Refer to the CMS website for additional information.

Prior to accessing ELGA/ELGH, you should verify the information listed above matches the information on the beneficiary's red, white and blue Medicare card.

You must also enter:

• Requestor ID (0011)
• CGS intermediary number (15004 for home health and hospice providers; 15201 for Ohio providers and 15101 for Kentucky providers)
• Your National Provider Identifier (NPI)

The following provides information about the ELGA/ELGH eligibility screens.

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Accessing ELGA and ELGH

1. To access ELGA and ELGH as you sign into the FISS, type the letters ELGA or ELGH on the 'Welcome to CMS EDC at HPES' screen (where you would normally type FSS0) and press ENTER.

   To access ELGA or ELGH if you are already in FISS, press F4 at any time to terminate your session. You will see the Session Successfully Terminated message on your screen.

   

   Type the letters ELGA or ELGH over the word Session and press ENTER.
   
   

   • The ability to access multiple sessions (FISS, ELGA and/or ELGH) simultaneously is available. Contact your connectivity vendor to learn how to access multiple sessions simultaneously.
   • Remember that ELGA and ELGH are not menu options within FISS. You must be in the process of signing on or off of FISS in order to access ELGA or ELGH.
     
     
2. Once you have pressed Enter, the CWF Part A Eligibility System screen appears. The fields, in which you type the beneficiary information, are identical for both the ELGA and ELGH eligibility screens.
   
   
3. Complete the required fields as indicated below.
   
   

   Field Name	What to Enter
   HIC / MBI NUMBER	The beneficiary's Medicare Beneficiary Identifier (MBI) number.
   ELIG FROM DATE	Enter the beginning service date (MMDDCCYY).
   ELIG THRU DATE	Enter the through dates of service, or the current date (MMDDCCYY)
   SURNAME	The beneficiary's last name (only accepts up to 6 letters). Note: If the beneficiary's name is John Smith Jr., enter "SMITHJ"
   INITIAL	The first letter of beneficiary's first name.
   DATE OF BIRTH	The beneficiary's date of birth in a MMDDCCYY format.
   SEX CODE	The beneficiary's gender (M or F).
   REQUESTOR ID	The requestor ID number 0011
   INTER NO	The Medicare intermediary number 15004 for home health and hospice providers, 15201 for Ohio providers, and 15101 for Kentucky providers.
   NPI NO	The National Provider Identifier (NPI).
   HOST ID	Usually left blank or insert one of the following. See the table under "Information About the HOST ID Field" found later in this section of the User Manual. GL – Great Lakes GW – Great Western KS – Keystone MA – Mid-Atlantic PA – Pacific NE – Northeast SE – Southeast SO – South SW – Southwest
   APP DATE	When left blank, the APP DATE field defaults to the current date. Entering a date into the APP DATE field (MMDDCCYY format) will affect the eligibility information that is displayed relating to: Medicare Secondary Payer (MSP) records Hospital/SNF stays Home health prospective payment system (HH PPS) episodes Hospice benefit periods Part B deductible Therapy cap More detailed information about using the APP DATE field can be found under the heading "Information about the APP DATE Field" found later in this section of the User Manual.
   REASON CODE	Reason for the inquiry: 1 – Status Inquiry (default)
   RESPONSE CODE	Indicates whether the inquiry is an actual test or CWF test inquiry: P – Production (default)

   
   
   • The example below illustrates how the CWF Part A Eligibility System screen looks after the information is completed, but before the Enter key is pressed.
     
     
4. Once you have keyed the information on the CWF Part A Eligibility System screen, press ENTER. The system will indicate that it's searching for the record.
   • If you receive an error message, refer to the "Error Messages" information.
5. When the information is entered accurately and the record is located at the host site, the first page of the beneficiary's eligibility record will display on your screen.
   • The eligibility record will have several pages of information. Use your F8 key to page forward through the beneficiary eligibility pages. Use your F7 key to page back.
6. If you want to look up another beneficiary's eligibility information or need to enter an APP DATE, press F1 from any of the CWF inquiry pages, and you will return to the CWF Part A Eligibility System screen.
7. When you are finished viewing the record, press F3. You will return to a blank screen. You may:
   1. type FSS0 and press ENTER to access FISS; or
   2. type logoff and press ENTER to return to the "TPX Menu" screen. Enter /k to return to the DXC Virtual Data Center screen

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Information about the HOST ID Field

The HOST ID field is related to different CWF host sites where beneficiary records are stored. Records are stored based on the location where the beneficiary's Social Security Number was issued. There are nine host sites as identified in the following table.

GL – Great Lakes Illinois Michigan Minnesota Wisconsin	MA – Mid-Atlantic Indiana Maryland Ohio Virginia West Virginia	SE – Southeast Alabama Kentucky Mississippi North Carolina South Carolina Tennessee
GW – Great Western (default) Idaho Iowa Kansas Missouri Montana Nebraska North Dakota Oregon South Dakota Utah Washington Wyoming	PA – Pacific Alaska Arizona California Hawaii Nevada	SO – South Florida Georgia
KS – Keystone Delaware New Jersey New York Pennsylvania	NE – Northeast Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont	SW – Southwest Arkansas Colorado Louisiana New Mexico Oklahoma Texas

• The default HOST-ID is always GW. If the beneficiary's information cannot be found at the default host site, you may need to look for the beneficiary's information at another host site by entering a two-character HOST-ID site (e.g., SO). You may need to try each of the different host sites before finding the beneficiary's information. Note: Once you have accessed beneficiary eligibility information, it is no longer necessary for you to enter the HOST ID code as the system retains this information.

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Information about the APP DATE Field

The ELGA and ELGH screens display beneficiary eligibility information. By using the APP DATE field, you can view the data that impacts your dates of services. When this field is left blank, the following eligibility information, if applicable, will display data based on the current date. By entering a date (MMDDCCYY) into the APP DATE field, the following information will display data based on the date entered:

Medicare Secondary Payer (MSP) records Hospital/SNF stays Home Health Prospective Payment System (HH PPS) episodes

Hospice benefit periods Part B deductible Therapy cap Medicare Advantage (MA) plans

To Access:	Action:
Prior MSP Records	Type the beneficiary's date of admission to your facility or the date services were provided by your facility. To access prior MSP records, type the beneficiary's Medicare Part A or Part B entitlement date in the APP DATE field. ELGH displays limited MSP information on screen page 04. ELGA displays more detailed MSP information. MSP information will appear beginning on ELGA screen page 18. One additional page will display for each MSP record that exist.
Prior Hospital/SNF Stay (This information is only available from ELGA.)	Type the beneficiary's date of admission to your facility or thedate services were provided by your facility. Screen page 01 of ELGA displays the dates of the most recent hospital/SNFbenefit perioddates in the DOEBA and DOLBA fields, based on the APP DATE entered. For the earliest hospital/SNF stay, type the beneficiary's MedicarePart A or Part B entitlement date in the APP DATE field. To find if a subsequenthospital/SNF stay occurred, enter a date in the APP DATE field that is one day after the DOLBA date of the hospital stay. Note: The information for the most current inpatient stay may notbe available if the hospital/SNF has not submitted their billing toMedicare. In addition, if a beneficiary has had multiple inpatient stays during a benefit period, you will see the date of admission of the earliest inpatient stay in the DOEBA field and the date of discharge of the latest inpatient stay in the DOLBA field, based on the APP date entered.
Prior HH PPS Episodes	Type the beneficiary's date of admission to your facility or the date services were provided by your facility. In certain instances such as a beneficiary transfer between home health agencies, it may be necessary to enter a date that is one calendar day prior to your date of admission or dates of service. Page 03 of ELGH displays the two most recent HH PPS episodes based on the APP DATE entered. Page 04 of ELGA displays similar information. To find if prior HH PPS episodes exist, type the date that is prior to the START DATE of the earliest episode listed. HHAs can also use these screens to determine whether there are any episodes which will impact where their episode falls within a series of adjacent episodes ("early" vs "late" episodes). In addition, HHAs can also determine whether prior episodes were fully denied and, therefore, not included in adjacent episode timing requirements. This information is also important to determine whether the patient was under an established home health plan of care. A screen print is required for documentation. Refer to "Beneficiary Elected Home Health Transfer" Web page for additional information.
Prior Hospice Benefit Periods	When the APP DATE field is left blank ELGA and ELGH will display the 5 most recent hospice benefit periods. To determine if there are any hospice benefit periods prior to the start date of Period 1, enter a date that is one day less than the START Date.
Prior Part B deductible	Type the beneficiary's date of admission to your facility or the date services were provided by your facility. Screen page 01 of ELGH or ELGA will provide the Part B deductible year and deductible amount remaining based on the APP DATE entered.
Prior Therapy Cap	Type the beneficiary's date of admission to your facility or the date services were provided by your facility. Screen page 01 of ELGH or ELGA will provide the therapy cap amount remaining for the year based on the APP DATE entered.
Prior Medicare Advantage (MA) plans	Type the beneficiary's date of admission to your facility or the date services were provided by your facility. To display prior MA plan information, the date entered in the APP DATE field must match the MA enrollment date, termination date, or be within the enrollment and termination date. Therefore, home health providers may need to enter a date for the 60 day episode period to determine if the beneficiary was enrolled in a MA plan during the home health episode.

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Error Messages

• If you receive an error message "Provider not on security file ," contact the CGS Electronic Data Interchange (EDI) department at 1.866.590.6703 (Part A) or 1.877.299.4500 (home health and hospice) and select Option 2 and request your security be modified to allow access to ELGA and/or ELGH.
• If the message "BENE-ERROR, BENEFICIARY RECORD NOT FOUND " displays, verify the information that was entered. There may be a data entry error preventing the system from finding the beneficiary's record. You may also want to enter various HOST ID codes, one at a time, to see if the beneficiary's record is at another HOST-ID site.
• If a message appears containing the phrase "TNIF " (True Not in File), the eligibility file is being updated and this update may prevent you from being able to access the eligibility file for a short period of time. Try accessing the file at a later time.
• If the message "Following Fields in Error – Correct and Resubmit " displays, not all of the required information is keyed or the information keyed is invalid. The message will also identify which field is in error.

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ELGA Screen Page 01 – Beneficiary Information (Beneficiary Entitlement, Hospital and SNF Days, Medicare Advantage Plan Information)

ELGA does not display periods of inactive eligibility for beneficiaries who are in the country unlawfully, have been deported or are incarcerated. However, inactive eligibility periods are available by accessing the Eligibility information in the myCGS online web portal. For additional information about myCGS, refer to the myCGS User Manual on the CGS website. Inactive eligibility information is also available from the Medicare Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS). For information about HETS, refer to the CMS website.

ELGA Screen Page 01 Field Descriptions

IP-REC	For intermediary use only.
CN	The beneficiary's Medicare Beneficiary Identifier (MBI) as entered on the Common Working File (CWF) Part A Eligibility System screen.
NM	The beneficiary's last name as entered on the CWF Part A Eligibility System screen.
IT	The first letter of beneficiary's first name as entered on the CWF Part A Eligibility System screen.
DB	The beneficiary's date of birth as entered on the CWF Part A Eligibility System screen.
SX	The beneficiary's gender as entered on the CWF Part A Eligibility System screen.
INT	The Medicare intermediary number as entered on the CWF Part A Eligibility System screen.

If any of the information shown in the above fields appears in a different color, note the correct information found in the corresponding field on the "correct" line. Ensure that you update your records and submit claims that reflect the correct information.

NPI	Your facility's National Provider Identifier (NPI) as entered on the CWF Part A Eligibility System screen.
APP	The date as entered in the APP DATE field on the CWF Part A Eligibility System screen. If APP DATE field is left blank, this field will be blank.
REAS	The reason for this inquiry as entered on the CWF Part A Eligibility System screen. Valid codes: 1 – Status Inquiry (default); 2 – Inquiry relating to an admission.
REQ	The requester ID as entered on the CWF Part A Eligibility System screen (0011).
DISP-CODE	Disposition Code: This field displays when a disposition code applies. Below are some common codes. Refer to the CMS Pub 100-04, Chapter 27 for information about disposition codes. 50 – Not in file 51 – Not in file on CMS batch system 52 – Host Site ID error on database 55 – Does not match a master record 60 – Input/Output error on date base 61 – Cross reference data base problem
MSG	The description of the disposition code (DISP CODE). This field only displays when one of the disposition codes listed above applies.

Information in the first five fields listed below (CORRECT CN, NM, IT, DB, SX) will only display if the data entered on the CWF Part A Eligibility System screen was incorrect or has been updated. When submitting claims to Medicare, use the corrected information to avoid claim submission errors. The remaining fields display the beneficiary's eligibility information.

CORRECT CN	Corrected claim number.
NM	Corrected name.
IT	Corrected initial.
DB	Corrected date of birth.
SX	Corrected sex code.
A-ENT	The beneficiary's date of entitlement to Medicare Part A benefits.
A-TRM	The beneficiary's date of termination from Medicare Part A benefits.
B-ENT	The beneficiary's date of entitlement to Medicare Part B benefits.
B-TRM	The beneficiary's date of termination from Medicare Part B benefits.
DOD	Date of death of the beneficiary.
LRSV	Lifetime Reserve. Number of lifetime reserve days remaining.
LPSY	Lifetime Psychiatric. Number of psychiatric days remaining.
FULL-HOSP	The full hospital inpatient days remaining in the current benefit period.
CO-HOSP	The hospital inpatient coinsurance days remaining in the current benefit period.
FULL-SNF	The full skilled nursing facility (SNF) days remaining in the current benefit period.
CO-SNF	The SNF coinsurance days remaining in the current benefit period.
IP-DED	The amount of inpatient deductible remaining to be met.
DOEBA	The date of earliest billing action for an inpatient spell of illness in the current benefit period.
DOLBA	The date of the latest billing action for an inpatient spell of illness in the current benefit period.
PART B YR	Most recent Part B year (CCYYMMDD).
DED-TBM	The amount of Part B cash deductible remaining to be met for the year.
PSYC	The psychiatric deductible used for the year.
PHYS THER APL	The physical therapy and speech-language pathology (combined) cap amount applied in the Part B year.
OCC THER APL	The occupational therapy cap amount applied in the Part B year.
FULL-NAME	The beneficiary's full name as it appears on the Common Working File (CWF) master record. When submitting claims to Medicare, use the full name as it appears in this field to avoid claim submission errors.
PLAN-TYPE	This field provides the type of Medicare Advantage (MA) plan (previously referred to Medicare Health Maintenance Organization (HMO)). Valid values are: HMO (Health Maintenance Organization) PPO (Preferred Provider Organization) FFS Demo (Fee-for-Service Demonstration) Indemnity POS (Point of Sale)
CURR ID	The MA plan identification code (5-digits): 1stdigit – Letter or number 2ndand 3rddigit – State Code 4th and 5th digit – MA plan number within the State You can use the PLAN-ID code to look up contact information for the MA plan by accessing the MA Plan directory. More information about accessing this resource is available below.
OPT	The MA plan Option Code. Describes the beneficiary's relationship with the MA plan. Valid codes are: 1 – Intermediary processes all (Part A and Part B) provider bill (unrestricted). Submit your claim to the intermediary. 2 – HMO processes directly provided services and arranged services. Intermediary processes all others (unrestricted). A – Intermediary processes all (Part A and Part B) provider bills (restricted). B – HMO to processes only bills for directly provided services (restricted); intermediary to process all other bills. C – HMO to process all bills (restricted). Submit your claim to the Medicare Advantage plan.
ENR	The MA plan enrollment date.
TERM	The MA plan termination date.

If the MA plan listed on this screen impacts your dates of service, CGS encourages providers to verify this information with the beneficiary. If the MA plan election listed is correct, providers must look to the MA plan for reimbursement and a claim should not be submitted to CGS, with the exception of Option Code 1. If the MA plan election is listed in error, a claim should not be submitted until the beneficiary's record has been updated. Access the following link from the CMS website and click "MA Plan Directory" to determine which MA plan is associated with the identification code and how to contact the plan to submit services for payment or update incorrect enrollment or termination dates, when appropriate (http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/MA-Plan-Directory.html)

ESRD: – CODE-1	The End Stage Renal Disease (ESRD) method of reimbursement (Method 1 or Method 2).
EFF DATE	The ESRD method of reimbursement effective date.
CODE-2	The ESRD method of reimbursement (Method 1 or Method 2).
EFF DATE	The ESRD method of reimbursement effective date.

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ELGA Screen Page 02 – Rehabilitation Sessions

ELGA Screen Page 02 Field Description

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

PULMONARY REMAINING: (HCPC: G0424)	The pulmonary rehabilitation services remaining.
CARDIAC APPLIED: (HCPCS: 93797, 93798)	The cardiac rehabilitation services applied.
ICR APPLIED: (HCPCS: G0422, G0423)	The intensive cardiac rehabilitation services applied.

 

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ELGA Screen Page 03 – Home Health Benefit Periods

Note: This screen should not be used to determine a beneficiary's status in a home health episode. (See "ELGA Screen Page 04" for home health episode information.)

ELGA Screen Page 03 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

EARLIEST BILLING DATE	The earliest home health billing date.
LATEST BILLING DATE	The latest home health billing date.
PART A VISITS REMAINING	The remaining Part A visits.
PART B VISITS APPLIED	The Part B visits that have been applied.

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ELGA Screen Page 04 – Home Health PPS Episodes

Note: This screen will display the two most recent Home Health Prospective Payment System (HH PPS) episodes based on the APP DATE entered in the CWF Part A Eligibility System screen.

ELGA Screen Page 04 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

EPIDODE START	The first day of the 60-day HH PPS episode. (Two most recent home health episodes.)
EPISODE END	The last day of the 60-day HH PPS episode. (Two most recent home health episodes.)
DOEBA	Date of Earliest Billing Action (DOEBA). The date of the first billable visit in the home health episode. If this field is blank or contains zeroes (0000000), a final claim has not been processed for this episode of care.
DOLBA	Date of Latest Billing Action (DOLBA). The date of the last billable visit in the home health episode. If this field is blank or contains zeroes (0000000), a final claim has not been processed for this episode of care.

This screen displays the two most recent HH PPS episodes based on the APP DATE entered. The most recent episode will appear on the top line. To determine if prior episodes exist, make a note of the earliest date that displays in the "EPISODE START" field, and press F1 to return to the CWF Part A Eligibility System screen. Ensure that all required fields are complete. Tab to the APP DATE field. Enter a date that is one day prior to the earliest episode start date. For example, if the date in the "EPISODE START" field appeared as 09172012, enter 09162012 in the APP DATE field and press Enter. ELGA Page 01 appears. Use your F8 key to page forward to ELGA Page 04. The two most recent HH PPS episodes, if there are any, will display based on the APP DATE entered. To see if additional episodes prior to the start date of these episodes exist, repeat the process by noting the earliest episode start date, pressing F1, and entering a date that is one day prior to the earliest episode start date in the APP DATE field.

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ELGA Screen Page 05 – Screening Information

ELGA Screen Page 05 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

HCPCS CODE	The HCPCS code for the screening service provided to this beneficiary.
TECH/PROF	Indicates whether the technical or professional component was billed. Valid entries: 26 – professional TC – technical
RECENT DATES OF SERVICE	The three most recent dates of service provided for each screening service HCPCS code listed (MMDDCCYY).

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ELGA Screen Page 06 – Next Eligible Date

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

PREVENTIVE SERVICE

The abbreviation of each preventive service and the associated HCPCS codes. Preventive Services Abbreviation HCPCS Cardiovascular CARDIOVASC 80061, 82465, 82718, 84478 Colorectal COLORECTAL G0104, G0105, G0106, G0120, G0121 Fecal Occult Blood Test FOB TEST G0107, G0328, 82270 Initial Preventive Physical Exam IPP EXAM G0344, G0366, G0367, G0368 Pelvic and Clinical Breast Exam PCB EXAM G0101 Pneumococcal Pneumonia Vaccine PV 90732, 90669, 90670 Prostate (including separate next eligible dates for digital rectal examination) PROSTATE G0102, G0103 Pap Test PAP TEST or PAPT Q0091, P3000, G0123, G0143, G0144, G0145, G0147, G0148 Diabetes DIABETES 82947, 82950, 82951 Glaucoma GLAU G0117, G0118 Mammography MAMM G0202, G0203, 76092, 77057, 77067

TECH DTE and PROF DTE

The next eligible technical or professional date the beneficiary can receive that preventive service. In the event, the beneficiary is not eligible for the preventive service, the technical and professional date fields will display an abbreviated message that explains why the beneficiary is not eligible. These abbreviated messages are: NOPTBENT or PTB Beneficiary not entitled to Part B or beneficiary's next eligible date is after their Medicare Part B termination date RECEIVED Beneficiary already received service DODNOELG Beneficiary not eligible due to date of death GDRNOELG Beneficiary not eligible due to gender AGENOELG Beneficiary not eligible due to age SRVNOELG Beneficiary not eligible for the service VACCINTD Beneficiary already vaccinated HCPCTERM HCPCS code for the preventive services has been terminated. 00000000 Service not applicable DODNOENT or DOD Next eligible date for the preventive service is after the beneficiary's date of death

It is important to keep in mind that the eligibility date is calculated based on claims payment history. As claims are processed, the eligibility dates may change; therefore, it is important for providers to check the eligibility status before providing a service.

The Centers for Medicare & Medicaid Services (CMS) has a variety of Medicare Learning Network (MLN) products related to preventive services. These resources are available on the CMS website

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ELGA Screen Page 07 – Next Eligible Date

ELGA Screen Page 07 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

PREVENTIVE SERVICE

The abbreviation of each preventive service and the associated HCPCS codes. Preventive Services Abbreviation HCPCS Abdominal Aortic Aneurysm AAA 76706, G0389 Initial Preventive Physical Exam IPP EXAM G0402, G0403, G0404, G0405 Pharmacogenomic Testing for Warfarin Response PTWR G9143 Annual Wellness Visit – Initial visit AWV G0438 Annual Wellness Visit – Subsequent visit AWV G0439 Hepatitis C Virus Screening HCAS G0472 Colorectal Cancer Screening COCS G0464 / 81528 Low Dose Computed tomography LDCT G0297 Human Immunodeficiency Virus Screening HIVS G0432, G0433, G0435, G0475 Human Papillomavirus Screening HPVS G0476 Hepatitis B Screening HBVS G0499

TECH DTE and PROF DTE

The next eligible technical or professional date the beneficiary can receive that preventive service. In the event, the beneficiary is not eligible for the preventive service, the technical and professional date fields will display an abbreviated message that explains why the beneficiary is not eligible. These abbreviated messages are: NOPTBENT or PTB Beneficiary not entitled to Part B or beneficiary's next eligible date is after their Medicare Part B termination date RECEIVED Beneficiary already received service DODNOELG Beneficiary not eligible due to date of death GDRNOELG Beneficiary not eligible due to gender AGENOELG Beneficiary not eligible due to age SRVNOELG Beneficiary not eligible for the service VACCINTD Beneficiary already vaccinated 00000000 Service not applicable HCPCTERM HCPCS code for the preventive service has been terminated. DODNOENT or DOD Next eligible date for the preventive service is after the beneficiary's date of death

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ELGA Screen Page 08 – Next Eligible Date

ELGA Screen Page 08 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

PREVENTIVE SERVICE	The abbreviation of each preventive service and the associated HCPCS codes.
TECH DTE and PROF DTE	The next eligible technical or professional date the beneficiary can receive that preventive service. In the event, the beneficiary is not eligible for the preventive service, the technical and professional date fields will display an abbreviated message that explains why the beneficiary is not eligible.

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ELGA Screen Page 09 – Next Eligible Date

ELGA Screen Page 09 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

PREVENTIVE SERVICE	The abbreviation of each preventive service and the associated HCPCS codes.
TECH DTE and PROF DTE	The next eligible technical or professional date the beneficiary can receive that preventive service. In the event, the beneficiary is not eligible for the preventive service, the technical and professional date fields will display an abbreviated message that explains why the beneficiary is not eligible.

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ELGA Screen Page 10 – HH Certification Plan of Care

Information will only display on Page 10 if the physician submitted their Part B claim for these services. Home health providers may use this information in conjunction with ELGH Page 03 and ELGA Page 04 to determine if the beneficiary is currently receiving or has received prior services under the Medicare home health benefit.

ELGA Screen Page 10 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

REC	Record number.
HCPCS	The HCPCS code submitted by the physician for services provided to certify that the beneficiary is eligible for home health services. Valid HCPCS codes are: G0179 – Physician re-certification for Medicare-covered home health services under a plan of care G0180 – Physician certification for Medicare-covered home health services under a plan of care
FROM DT	The date of services for either of the two codes above when these codes have been paid.

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ELGA Screen Page 11 – Telehealth Service Next Elig Date

ELGA Screen Page 11 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

TELEHEALTH SERVICES: HOSPITAL CARE	Fields that appear below this heading apply to subsequent hospital care services.
HCPCS:	HCPCS codes for subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days.
NEXT ELIGIBILE DATE:	The next eligible date is based on previously received telehealth services for hospital care service. Valid values include: MM/DD/CCYY If a date is present, the next eligible date is the 4th day after the posted date. If the beneficiary had no previous hospital care services the next eligible date field will display 01/01/2011. If the beneficiary's Part B entitlement date is after the effective date of the hospital care services, the Part B entitlement date is the next eligible date. NOPTBENT Beneficiary is not entitled to Medicare Part B. DODNOENT Next eligibility date falls after the date of death.
RULE:	The Medicare guideline for telehealth services.
TELEHEALTH SERVICES: NURSING CARE	Fields that appear below this heading apply to subsequent nursing facility care services.
HCPCS:	HCPCS codes for subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days.
NEXT ELIGIBILE DATE:	The next eligible date is based on previously received telehealth services for nursing facility care services. Valid values include: MM/DD/CCYY If a date is present, the next eligible date is the 31st day after the posted date. If the beneficiary had no previous nursing facility care services the next eligible date field will display 01/01/2011. If the beneficiary's Part B entitlement date is after the effective date of the nursing facility care services, the Part B entitlement date is the next eligible date. NOPTBENT Beneficiary is not entitled to Medicare Part B. DODNOENT Next eligibility date falls after the date of death.
RULE:	The Medicare guideline for telehealth services.

 

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ELGA Screen Page 12 – Behavioral Services

ELGA Screen Page 12 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

ALCOHOL ABUSE: (G0442)	The behavioral service and its associated HCPCS
NEXT ELIG PROF	Next eligible professional date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
ALCOHOL SCREENING: (G0443)	The behavioral service and its associated HCPCS
NEXT ELIG PROF	Next eligible professional date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
REM	Remaining behavioral services available.
ADULT DEPRESSION: (G0444)	The behavioral service and its associated HCPCS
NEXT ELIG TECH	Next eligible technical date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
NEXT ELIG PROF	Next eligible professional date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
IBT FOR CVD: (G0446)	The behavioral service and its associated HCPCS
NEXT ELIG TECH	Next eligible technical date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
NEXT ELIG PROF	Next eligible professional date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
OBESITY: (G0447)	The behavioral service and its associated HCPCS
NEXT ELIG TECH	Next eligible technical date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
NEXT ELIG PROF	Next eligible professional date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
REM	Remaining behavioral services available.
OBESITY: (G0447, G0473)	The preventive service and its associated HCPCS
NEXT ELIG TECH	Next eligible technical date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
NEXT ELIG PROF	Next eligible professional date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
REM	Remaining behavioral services available.

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ELGA Screen Page 13 – HIBC Counselling

ELGA Screen Page 13 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

STIS: (G0445)	Sexually Transmitted Infections (STIs) and HCPCS.
NEXT ELIG TECH DATE:	Next eligible technical date for the service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death
STIS: (G0445)	Sexually Transmitted Infections (STIs) and HCPCS.
NEXT ELIG PROF DATE:	Next eligible professional date for the service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death

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ELGA Screen Page 14 – Bone Density Service Next Elig Date

ELGA Screen Page 14 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

HCPCS:	HCPCS codes associated with bone density testing.
NEXT ELIG TECH DATE:	Next eligible technical date for bone density testing. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death
NEXT ELIG PROF DATE:	Next eligible professional date for bone density testing. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death
RULE	The Medicare preventative benefit provided for bone density testing.

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ELGA Screen Page 15 – Medicare Care Choices Model

ELGA Screen Page 15 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

PROVIDER NUMBER	The provider number of the hospice who is participating in the Medicare Care Choice Model (MCCM).
START DATE	The beginning date of a beneficiary's election with the hospice provider participating in the MCCM.
TERM DATE	The ending date of a beneficiary's election of the hospice provider participating in the MCCM.
TRANSFER DATE	The date of the MCCM hospice provider change of ownership.

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ELGA Screen Page 16 – Supervised Exercise Therapy Sessions

ELGA Screen Page 16 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

SET SESSIONS REMAINING TECH

The number of Supervised Exercise Therapy (SET) sessions remaining.

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ELGA Screen Page 17 – Hospice Election Period

ELGA Screen Page 17 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

HOSPICE ELECTION PERIOD	A maximum of four most recent hospice election periods display
ELECT DATE	Hospice election start date (MMDDCCYY).
RECIPT DATE	Receipt date (MMDDCCYY). The receipt date of the hospice notice of election (NOE). This field is updated when an NOE (type of bill 8xA) is processed. This date will be retained on the election period permanently.
REVOC DATE	The revocation indicator showing whether the Hospice election period is active. (MMDDCCYY)
REVOC IND	The revocation indicator shows whether the hospice election period is active or revoked. Zero (0) means the election period is active. Anything other than zero (0) indicates the hospice period is revoked.
PROVIDER	The hospice provider number.
NPI	The hospice provider's National Provider Identifier (NPI).

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ELGA Screen Page 18 – Hospice Information

ELGA Screen Page 18 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

IMMUNO/TRAMS	Line 3 provides immunosuppressive/transplant information
TRANS ID	This identifies whether the beneficiary has received a Medicare covered transplant. Valid codes are: 1 Allograft bone marrow – transplant from another person 2 Autograft bone marrow – transplant from beneficiary B Lung transplant C Heart and lung transplant D Kidney and pancreas transplant H Heart transplant I Intestinal transplant K Kidney transplant L Liver transplant P Pancreas transplant
DISCHARGE DATE	Date of hospital discharge following transplant.
The following fields display up to five hospice periods.
START DATE	The start date of the hospice benefit period
TERM DATE	The term date of the hospice benefit period
REVOC IND	The revocation indicator shows whether the hospice election period is active or revoked. Zero (0) means the election period is active. Anything other than zero (0) indicates the hospice period is revoked.

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ELGA Screen Page 19 – Smoking Cessation

ELGA Screen Page 19 Field Description:

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

TOTAL TECH SESSIONS	The total number of technical sessions per counseling period.
TOTAL PROF SESSIONS	The total number of professional sessions per counseling period.
HCPCS	The HCPCS code identifying the level of smoking and tobacco-use cessation counseling.
FROM	From date of service in MM/DD/CCYY format.
THRU	Through date of service in MM/DD/CCYY format.
PER	Period number.
QT	Quantity.
TP	Claim type.

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ELGA Screen Page 20 – Radiation Oncology Model

ELGA Screen Page 20 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

HCPCS	The professional radiation oncology model-specific HCPCS code.
ACT SOE	Actual start of episode date.
ACT EOE	Actual end of episode date.
DIAGNOSIS CODE	Professional line item diagnosis code.
TAX ID NUM	The Tax Identification Number (TIN) of the radiation oncologists performing the service.
RENDER NPI	The National Provider Identifier (NPI) of the radiation oncologists performing the service.
TEMP SOE	Temporary start of episode date.
TEMP EOE	Temporary end of episode date.
CCN	Facility/Technical participant provider number.

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ELGA Screen Page 21 – Radiation Oncology Model

ELGA Screen Page 21 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

HCPCS	The professional radiation oncology model-specific HCPCS code.
ACT SOE	Actual start of episode date.
ACT EOE	Actual end of episode date.
DIAGNOSIS CODE	Professional line item diagnosis code.
TAX ID NUM	The Tax Identification Number (TIN) of the radiation oncologists performing the service.
RENDER NPI	The National Provider Identifier (NPI) of the radiation oncologists performing the service.
TEMP SOE	Temporary start of episode date.
TEMP EOE	Temporary end of episode date.
CCN	Facility/Technical participant provider number.

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ELGA Screen Page 22 – MSP Information

If MSP information is not applicable to the beneficiary, page 22 will not display. Additional pages, beyond page 22, will display if more than one MSP record exists.

This page displays Medicare Secondary Payer (MSP) information only when another insurance company is primary to Medicare. Supplemental insurer information (insurance which is secondary to Medicare), such as Medigap and Medicaid, will not appear on these screens. For Medicare Advantage (MA) plan information, refer to "ELGA Screen Page 01".

MSP records that have been termed are not viewable without the use of the "APP DATE" field. Review the information under the heading "Information about the APP DATE Field" found earlier to ensure you review data that may impact your dates of service.

ELGA Screen Page 22 Field Descriptions

The top line of information is carried over from the ELGA screen page 01. Refer to the "ELGA Screen Page 01 Field Descriptions" for information about these fields.

MSP CODE	Valid MSP code indicator. Valid values are: 12 = Working Aged 13 = End Stage Renal Disease (ESRD) 14 = Auto/Liability 15 = Worker's Compensation 16 = Federal – Public Health 41 = Black Lung 43 = Disabled 47 = Any Liability
EFF DATE	Effective date of the primary insurance.
TERM DATE	Termination date of the primary insurance.
INSURER INFORMATION	NAME Primary Insurer's Name ADDRESS 1 and 2 Primary Insurer's Address CITY Primary Insurer's City STATE Primary Insurer's State ZIP Primary Insurer's Zip Code POLICY NO Policy Number of Primary Insurance

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ELGH Screen Page 01 – Beneficiary Information

1. To access ELGH, follow steps 1 through 7 under "Accessing ELGA and ELGH". The following screen illustrations and field descriptions apply to the ELGH screens.
   
   

ELGA does not display periods of inactive eligibility for beneficiaries who are in the country unlawfully, have been deported or are incarcerated. However, inactive eligibility periods are available by accessing the Eligibility information in the myCGS online web portal. For additional information about myCGS, refer to the myCGS User Manual on the CGS website. Inactive eligibility information is also available from the Medicare Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS). For information about HETS, refer to the CMS website.

ELGH Screen Page 01 Field Descriptions

IP-REC	For intermediary use only.
CN	The beneficiary's Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI) number as entered on the Common Working File (CWF) Part A Eligibility System screen.
NM	The beneficiary's last name as entered on the CWF Part A Eligibility System screen.
IT	The first initial of the beneficiary's first name as entered on the CWF Part A Eligibility System screen.
DB	The beneficiary's date of birth as entered on the CWF Part A Eligibility System screen.
SX	The beneficiary's gender as entered on the CWF Part A Eligibility System screen.
INT	The Medicare intermediary number as entered on the CWF Part A Eligibility System screen (15004).

If any of the information shown in the above fields appears in a different color, note the correct information found in the corresponding field on the "CORRECT" line. Ensure that you update your records and submit claims that reflect the correct information.

NPI	Your facility's National Provider Identifier (NPI) as entered on the CWF Part A Eligibility System screen.
APP	The date as entered in the APP DATE field on the CWF Part A Eligibility System. If the APP DATE field was left blank, this field will be blank.
REAS	The reason for this inquiry as entered on the CWF Part A Eligibility System. Valid codes: 1 – Status inquiry (default) 2 – Inquiry relating to an admission
REQ	The requestor ID as entered on the CWF Part A Eligibility System (0011).
DISP CODE	Disposition Code: This field displays when a disposition code applies. Below are some common codes. Refer to the CMS Pub 100-04, Chapter 27 for information about disposition codes. 50 – Not in file 51 – Not in file on CMS batch system 52 – Host Site ID error on database 53 – Not in file in CMS but possible resolution 55 – Does not match a master record 60 – Input/Output error on date base 61 – Cross reference data base problem
MSG	The description of the disposition (DISP CODE)

Information in the first five fields listed below (CORRECT CN, NM, IT, DB, SX) will only display if the data entered on the CWF Part A Eligibility System screen was incorrect or has been updated. When submitting claims to Medicare, use the corrected information to avoid claim submission errors. The remaining fields display the beneficiary's eligibility information.

CORRECT CN	Corrected claim number.
NM	Corrected name.
IT	Corrected initial.
DB	Corrected date of birth.
SX	Corrected sex code.
A-ENT	The beneficiary's date of entitlement to Medicare Part A benefits.
A-TRM	The beneficiary's date of termination from Medicare Part A benefits.
B-ENT	The beneficiary's date of entitlement to Medicare Part B benefits.
B-TRM	The beneficiary's date of termination from Medicare Part B benefits.
DOD	Date of death of the beneficiary.
PART B YR	Most recent Part B year (CCYYMMDD).
DED-TBM	The amount of the Part B cash deductible remaining to be met for the current year.
FULL-NAME	The beneficiary's full name as it appears on the Common Working File (CWF) master record. Ensure your claim is submitted with the beneficiary's name as it appears here.
PT APL	The physical therapy and speech-language pathology (combined) cap amount applied in the Part B year.
OT APL	The occupational therapy cap amount applied in the Part B year. See above "Note".

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ELGH Screen Page 02 – Home Health Benefit Periods

Note: This screen should not be used to determine a beneficiary's status in a home health episode. (See ELGH Screen Page 03 for home health episode information.)

ELGH Screen Page 02 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

EARLIEST BILLING DATE	The earliest home health billing date in the benefit period.
LATEST BILLING DATE	The latest home health billing date in the benefit period.

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ELGH Screen Page 03 – Home Health PPS Episodes

Note: This screen will display the two most recent home health PPS episodes based on the APP DATE entered in the CWF Part A Eligibility System screen. If the APP DATE field is left blank, the most current information will display. Depending upon the episode information currently available for the beneficiary on this page, you may also need to review the information on ELGA Page 04.

ELGH Screen Page 03 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

START DATE	The first day of the 60-day Home Health Prospective Payment System (HH PPS) episode.
END DATE	The last day of the 60-day HH PPS episode.
INTER NUM	The intermediary number of the Medicare contractor that processed the home health billing transaction that established the episode of care.
NPI NUM	The National Provider Identifier (NPI) number of the home health agency providing home health services.
PATSTAT	The patient status code submitted on the most recent home health billing transaction (request for anticipated payment (RAP) or claim). When a "30" is displayed in this field, HHAs should also review the information on ELGA Page 04 to determine if the last billing transaction was a RAP or a final claim. A patient status code other than "30" indicates the primary HHA discharged the beneficiary from their care.
CAN-IND	Valid Cancel Indicator 0 = RAP not cancelled 1 = RAP cancelled 2 = Full medical review claim denial 3 = Demand denial

This screen displays the two most recent HH PPS episodes based on the APP DATE entered. The most recent episode will appear on the top line. To determine if prior episodes exist, make a note of the earliest date that displays in the "START DATE" field, and press F1 to return to the CWF Part A Eligibility System screen. Ensure that all required fields are complete. Tab to the APP DATE field. Enter a date that is one day prior to the earliest episode start date. For example, if the date in the "START DATE" field appeared as 09172012, enter 09162012 in the APP DATE field and press Enter. ELGH Page 01 appears. Use your F8 key to page forward to ELGH Page 03. The two most recent HH PPS episodes, if there are any, will display based on the APP DATE entered. To see if additional episodes prior to the start date of these episodes exist, repeat the process by noting the earliest episode start date, pressing F1, and entering a date that is one day prior to the earliest episode start date in the APP DATE field.

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ELGH Screen Page 04 – MSP Information

This page displays Medicare Secondary Payer (MSP) information only when another insurance company is primary to Medicare. Supplemental insurer information (insurance which is secondary to Medicare), such as Medigap and Medicaid, will not appear on these screens. For Medicare Advantage (MA) plan information, press F8 and refer to the following page, "ELGH Screen Page 05 – Plan Information".

MSP records that have been termed are not viewable without the use of the "APP DATE" field. Review the information under the heading "Information about the APP DATE Field" found earlier in this chapter to ensure that you review data that may impact your dates of service.

ELGH Screen Page 04 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

REC	The record number (line number) for MSP information. The beneficiary may have more than one record.
MSP CODE	MSP code indicator. Valid values are: 12 = Working Aged 13 = End Stage Renal Disease (ESRD) 14 = Auto/Liability 15 = Worker's Compensation 16 = Federal – Public Health 41 = Black Lung 43 = Disabled 47 = Any Liability
EFF DATE	Effective date of the primary insurance (MM/DD/CCYY).
TERM DATE	Termination date of the primary insurance (MM/DD/CCYY).

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ELGH Screen Page 05 – Plan Information

Providers should be aware that Medicare Advantage (MA) plans differ from Medicare Secondary Payer (MSP) records (ELGH Page 04) in that a beneficiary's enrollment in an MA plan is an alternative to traditional Medicare benefits (Part A and Part B). Therefore, reimbursement for services will either be from the MA plan (also known as Medicare Part C) or traditional Medicare.

ELGH Screen Page 05 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

PLAN-TYPE	This field provides the type of Medicare Advantage (MA) plan. Valid values are: HMO (Health Maintenance Organization) PPO (Preferred Provider Organization) FFS Demo (Fee-for-Service Demonstration) Indemnity POS (Point of Sale)
PLAN-ID	The MA plan identification code (5-digits): 1stdigit – Letter or number 2nd and 3rd digit – State Code 4th and 5thdigit – Medicare Advantage plan number within the state You can use the PLAN-ID code to look up contact information for the MA plan by accessing the MA Plan directory. More information about accessing this resource is available below.
OPT	Option Code. The MA plan identification code. Describes the beneficiary's relationship with the MA plan. Valid codes are: 1 – Intermediary processes all (Part A and Part B) provider bills (unrestricted). Submit your claim to the intermediary. 2 – HMO processes directly provided services and arranged services. Intermediary processes all others (unrestricted). A – Intermediary processes all (Part A and Part B) provider bills (restricted) B – HMO to process only bills for directly provided services (restricted); intermediary to process all other bills. C – HMO to process all bills (restricted). Submit your claim to the Medicare Advantage plan.
ENR-DATE	The MA plan effective date (MMDDCCYY).
TRM DATE	The MA plan termination date (MMDDCCYY).

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ELGH Screen Page 06 – Next Eligible Date

ELGH Screen Page 06 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

PREVENTIVE SERVICE

The abbreviation of each preventive service and the associated HCPCS codes. Preventive Services Abbreviation HCPCS Cardiovascular CARDIOVASC 80061, 82465, 82718, 84478 Colorectal COLORECTAL G0104, G0105, G0106, G0120, G0121 Fecal Occult Blood Test FOB TEST G0107, G0328, 82270 Initial Preventive Physical Exam IPP EXAM G0344, G0366, G0367, G0368 Pelvic and Clinical Breast Exam PCB EXAM G0101 Pneumococcal Pneumonia Vaccine PV 90732, 90669, 90670 Prostate (including separate next eligible dates for digital rectal examination) PROSTATE G0102, G0103 Pap Test PAP TEST or PAPT Q0091, P3000, G0123, G0143, G0144, G0145, G0147, G0148 Diabetes DIABETES 82947, 82950, 82951 Glaucoma GLAU G0117, G0118 Mammography MAMM G0202, G0203, 76092, 77057, 77067

TECH DTE and PROF DTE

The next eligible technical or professional date the beneficiary can receive that preventive service. In the event, the beneficiary is not eligible for the preventive service, the technical and professional date fields will display an abbreviated message that explains why the beneficiary is not eligible. These abbreviated messages are: NOPTBENT or PTB Beneficiary not entitled to Part B or beneficiary's next eligible date is after their Medicare Part B termination date RECEIVED Beneficiary already received service DODNOELG Beneficiary not eligible due to date of death GDRNOELG Beneficiary not eligible due to gender AGENOELG Beneficiary not eligible due to age SRVNOELG Beneficiary not eligible for the service VACCINTD Beneficiary already vaccinated HCPCTERM HCPCS code for the preventive services has been terminated 00000000 Service not applicable DODNOENT or DOD Next eligible date for the preventive service is after the beneficiary's date of death

It is important to keep in mind that the eligibility date is calculated based on claims payment history. As claims are processed, the eligibility dates may change; therefore, it is important for providers to check the eligibility status before providing a service.

Review the Medicare Preventive Services education tool on the Centers for Medicare & Medicaid Services (CMS) website for a variety of resources.

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ELGH Screen Page 07 – Next Eligible Date

ELGH Screen Page 07 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

PREVENTIVE SERVICE

The abbreviation of each preventive service and the associated HCPCS codes. Preventive Services Abbreviation HCPCS Abdominal Aortic Aneurysm AAA 76706, G0389 Initial Preventive Physical Exam IPP EXAM G0402, G0403, G0404, G0405 Pharmacogenomic Testing for Warfarin Response PTWR G9143 Annual Wellness Visit – Initial visit AWV G0438 Annual Wellness Visit – Subsequent visit AWV G0439 Hepatitis C Virus Screening HCAS G0472 Colorectal Cancer Screening COCS G0464 / 81528 Low Dose Computed Tomography LDCT G0297 Human Immunodeficiency Virus Screening HIVS G0432, G0433, G0435, G0475 Human Papillomavirus Screening HPVS G0476 Hepatitis B Screening HBVS G0499

TECH DTE and PROF DTE

The next eligible technical or professional date the beneficiary can receive that preventive service. In the event, the beneficiary is not eligible for the preventive service, the technical and professional date fields will display an abbreviated message that explains why the beneficiary is not eligible. These abbreviated messages are: NOPTBENT or PTB Beneficiary not entitled to Part B or beneficiary's next eligible date is after their Medicare Part B termination date RECEIVED Beneficiary already received service DODNOELG Beneficiary not eligible due to date of death GDRNOELG Beneficiary not eligible due to gender AGENOELG Beneficiary not eligible due to age SRVNOELG Beneficiary not eligible for the service VACCINTD Beneficiary already vaccinated 00000000 Service not applicable HCPCTERM HCPCS code for the preventive service has been terminated. DODNOENT or DOD Next eligible date for the preventive service is after the beneficiary's date of death

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ELGH Screen Page 08 – Next Eligible Date

ELGH Screen Page 08 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

PREVENTIVE SERVICE	The abbreviation of each preventive service and the associated HCPCS codes.
TECH DTE and PROF DTE	The next eligible technical or professional date the beneficiary can receive that preventive service. In the event, the beneficiary is not eligible for the preventive service, the technical and professional date fields will display an abbreviated message that explains why the beneficiary is not eligible.

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ELGH Screen Page 09 – Next Eligible Date

ELGH Screen Page 09 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

PREVENTIVE SERVICE	The abbreviation of each preventive service and the associated HCPCS codes.
TECH DTE and PROF DTE	The next eligible technical or professional date the beneficiary can receive that preventive service. In the event, the beneficiary is not eligible for the preventive service, the technical and professional date fields will display an abbreviated message that explains why the beneficiary is not eligible.

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ELGH Screen Page 10 – Rehabilitation Sessions

ELGH Screen Page 10 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

PULMONARY REMAINING: (HCPC: G0424)	The pulmonary rehabilitation services remaining.
CARDIAC APPLIED: (HCPCS: 93797, 93798)	The cardiac rehabilitation services applied.
ICR APPLIED: (HCPCS: G0422, G0423)	The intensive cardiac rehabilitation services applied.

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ELGH Screen Page 11 – HH Certification Plan of Care

Information will only display on Page 11 if the physician submitted their Part B claim for these services. Home health providers may use this information in conjunction with ELGH Page 03 and ELGA Page 04 to determine if the beneficiary is currently receiving or has received prior services under the Medicare home health benefit.

ELGH Screen Page 11 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

REC	Record number.
HCPCS	The HCPCS code submitted by the physician for services provided to certify that the beneficiary is eligible for home health services. Valid HCPCS codes are: G0179 – Physician re-certification for Medicare-covered home health services under a plan of care G0180 – Physician certification for Medicare-covered home health services under a plan of care
FROM DT	The date of service for either of the two codes above when these codes have been paid.

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ELGH Screen Page 12 – Telehealth Service Next Elig Date

ELGH Screen Page 12 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

TELEHEALTH SERVICES: HOSPITAL CARE	Fields that appear below this heading apply to subsequent hospital care services.
HCPCS:	HCPCS codes for subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days.
NEXT ELIGIBILE DATE:	The next eligible date is based on previously received telehealth services for hospital care service. Valid values include: MM/DD/CCYY If a date is present, the next eligible date is the 4th day after the posted date. If the beneficiary had no previous hospital care services the next eligible date field will display 01/01/2011. If the beneficiary's Part B entitlement date is after the effective date of the hospital care services, the Part B entitlement date is the next eligible date. NOPTBENT Beneficiary is not entitled to Medicare Part B. DODNOENT Next eligibility date falls after the date of death.
RULE:	The Medicare guideline for telehealth services.
TELEHEALTH SERVICES: NURSING CARE	Fields that appear below this heading apply to subsequent nursing facility care services.
HCPCS:	HCPCS codes for subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days.
NEXT ELIGIBILE DATE:	The next eligible date is based on previously received telehealth services for nursing facility care services. Valid values include: MM/DD/CCYY If a date is present, the next eligible date is the 31st day after the posted date. If the beneficiary had no previous nursing facility care services the next eligible date field will display 01/01/2011. If the beneficiary's Part B entitlement date is after the effective date of the nursing facility care services, the Part B entitlement date is the next eligible date. NOPTBENT Beneficiary is not entitled to Medicare Part B. DODNOENT Next eligibility date falls after the date of death.
RULE:	The Medicare guideline for telehealth services.

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ELGH Screen Page 13 – Behavioral Services

ELGH Screen Page 13 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

ALCOHOL ABUSE: (G0442)	The behavioral service and its associated HCPCS
NEXT ELIG PROF	Next eligible professional date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
ALCOHOL SCREENING: (G0443)	The behavioral service and its associated HCPCS
NEXT ELIG PROF	Next eligible professional date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
REM	Remaining behavioral services available.
ADULT DEPRESSION: (G0444)	The behavioral service and its associated HCPCS
NEXT ELIG TECH	Next eligible technical date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
NEXT ELIG PROF	Next eligible professional date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
IBT FOR CVD: (G0446)	The behavioral service and its associated HCPCS
NEXT ELIG TECH	Next eligible technical date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
NEXT ELIG PROF	Next eligible professional date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
OBESITY: (G0447)	The behavioral service and its associated HCPCS
NEXT ELIG TECH	Next eligible technical date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
NEXT ELIG PROF	Next eligible professional date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
REM	Remaining behavioral services available.
OBESITY: (G0447, G0473)	The preventive service and its associated HCPCS
NEXT ELIG TECH	Next eligible technical date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
NEXT ELIG PROF	Next eligible professional date for the behavioral service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death SVCNOELG – Beneficiary not eligible for the service
REM	Remaining behavioral services available.

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ELGH Screen Page 14 – HIBC Counselling

ELGH Screen Page 14 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

STIS: (G0445)	Sexually Transmitted Infections (STIs) and HCPCS.
NEXT ELIG TECH DATE:	Next eligible technical date for the service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death
STIS: (G0445)	Sexually Transmitted Infections (STIs) and HCPCS.
NEXT ELIG PROF DATE:	Next eligible professional date for the service. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death

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ELGH Screen Page 15 – Bone Density Service Next Elig Date

ELGH Screen Page 15 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

HCPCS:	HCPCS codes associated with bone density testing.
NEXT ELIG TECH DATE:	Next eligible technical date for bone density testing. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death
NEXT ELIG PROF DATE:	Next eligible professional date for bone density testing. (MM/DD/CCYY) May also display: NOPTBENT – Beneficiary not entitled to Part B DODNOELG – Beneficiary not eligible due to date of death
RULE	The Medicare preventative benefit provided for bone density testing.

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ELGH Screen Page 16 – Medicare Care Choices Model

ELGH Screen Page 16 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

PROVIDER NUMBER	The provider number of the hospice who is participating in the Medicare Care Choices Model (MCCM).
START DATE	The beginning date of a beneficiary's election with the hospice provider participating in the MCCM.
TERM DATE	The ending date of a beneficiary's election of the hospice provider participating in the MCCM.
TRANSFER DATE	The date of the MCCM hospice provider change of ownership.

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ELGH Screen Page 17 – Supervised Exercise Therapy Sessions

ELGH Screen Page 17 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

SET SESSIONS REMAINING TECH

The number of Supervised Exercise Therapy (SET) sessions remaining.

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ELGH Screen Page 18 – Hospice Election Period

ELGH Screen Page 18 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

HOSPICE ELECTION PERIOD	A maximum of four most recent hospice election periods display
ELECT DATE	Hospice election start date (MMDDCCYY).
RECIPT DATE	Receipt date (MMDDCCYY). The receipt date of the hospice notice of election (NOE). This field is updated when an NOE (type of bill 8xA) is processed. This date will be retained on the election period permanently.
REVOC DATE	The revocation indicator showing whether the Hospice election period is active. (MMDDCCYY)
REVOC IND	The revocation indicator shows whether the hospice election period is active or revoked. Zero (0) means the election period is active. Anything other than zero (0) indicates the hospice period is revoked.
PROVIDER	The hospice provider number.
NPI	The hospice provider's National Provider Identifier (NPI).

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ELGH Screen Page 19 – Hospice Information

ELGH Screen Page 19 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

START DATE	The start date of the hospice benefit period
TERMDATE	The term date of the hospice benefit period
PROVIDER NO	The hospice provider number.
INTER NO	The number identifying the Medicare Administrative Contractor (MAC) that processed the hospice claim.
REVOC IND	The revocation indicator shows whether the hospice election period is active or revoked. Zero (0) means the election period is active. Anything other than zero (0) indicates the hospice period is revoked.

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ELGH Screen Page 20 – Smoking Cessation

ELGH Screen Page 20 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

TOTAL TECH SESSIONS	The total technical number of sessions per counseling period.
TOTAL PROF SESSIONS	The total professional number of sessions per counseling period.
HCPCS	The HCPCS code identifying the level of smoking and tobacco-use cessation counseling.
FROM	From date of service in MM/DD/CCYY format.
THRU	Through date of service in MM/DD/CCYY format.
PER	Period number.
QT	Quantity.
TP	Claim type.

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ELGH Screen Page 21 – Radiation Oncology Model

ELGH Screen Page 21 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

HCPCS	The professional radiation oncology model-specific HCPCS code.
ACT SOE	Actual start of episode date.
ACT EOE	Actual end of episode date.
DIAGNOSIS CODE	Professional line item diagnosis code.
TAX ID NUM	The Tax Identification Number (TIN) of the radiation oncologists performing the service.
RENDER NPI	The National Provider Identifier (NPI) of the radiation oncologists performing the service.
TEMP SOE	Temporary start of episode date.
TEMP EOE	Temporary end of episode date.
CCN	Facility/Technical participant provider number.

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ELGH Screen Page 22 – Radiation Oncology Model

ELGH Screen Page 22 Field Descriptions

The top line of information is carried over from the ELGH screen page 01. Refer to the "ELGH Screen Page 01 Field Descriptions" for information about these fields.

HCPCS	The professional radiation oncology model-specific HCPCS code.
ACT SOE	Actual start of episode date.
ACT EOE	Actual end of episode date.
DIAGNOSIS CODE	Professional line item diagnosis code.
TAX ID NUM	The Tax Identification Number (TIN) of the radiation oncologists performing the service.
RENDER NPI	The National Provider Identifier (NPI) of the radiation oncologists performing the service.
TEMP SOE	Temporary start of episode date.
TEMP EOE	Temporary end of episode date.
CCN	Facility/Technical participant provider number.

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