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CGS Administrators, LLC

IVR: 866.238.9650 Customer Service and myCGS: 866.270.4909

What to do when a claim denies

Why did my claim get denied?

This section provides useful information on determining why your claim may have denied and what you need to do to correct the claim for payment consideration.

Claim Denial Resolution Tool

This tool has been developed to provide the supplier community guidance on how to address claim denials in the most efficient manner. Enter the Reason Code and Remark Code (if applicable) from your Remittance Advice into the tool to receive the reason for denial along with possible causes and resolution.

Ordering/Referring Provider Denial Job Aid
The following guide will provide useful information regarding the next steps to be taken when you receive a claim rejection/denial due to a missing/incomplete/invalid ordering provider name or NPI.
CGS Wizard

CGS Wizard contains processed claim details for all claims submitted to Jurisdiction C, ADR status, medical review decisions and resources directly from our website! Just enter a 14-digit CCN (claim control number) and CGS Wizard will give you the claim and/or medical review denial details you need to resubmit your claim!

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