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CGS Administrators, LLC

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CGSConnect

CGS Connect™

Originally published 08/13/2015
Revised: 02/20/2019

CGS Connect™ is a unique concierge-level service offered exclusively for Jurisdiction C suppliers seeking professional review and evaluation of pre-claim documentation before submitting an initial claim to Medicare.

CGS Connect™ is a voluntary program that provides you with a higher level of assurance that your supporting documentation meets the necessary requirements to process your claim for payment consideration.

CGS Connect™ is not a prior approval or authorization program. Participation in CGS Connect™ does not exempt suppliers from the audit process. Our review and recommendations under the CGS Connect™ program are for educational purposes only and do not guarantee payment for services billed. CGS Connect™ does offer you professional evaluation of your pre-claim documentation and it provides you with individualized education to prevent future documentation-related errors.

Here's How It Works:

As a Jurisdiction C supplier, you may request clinical review of your pre-claim documentation.

When you request a clinical review through CGS Connect™, our professional Medical Review clinicians will evaluate your pre-claim documentation using their applied medical knowledge of policy-based requirements. When necessary, the clinician will contact you directly to discuss their evaluation and recommendations. In all cases, you will be provided with documented, detailed feedback regarding your submission. You will then have the opportunity to correct the errors in the documentation (if possible) and submit the claim for processing. CGS Connect allows subsequent submissions for a review request after the supplier has had the opportunity to make improvements. Subsequent submissions must be received within 30 days of the initial request.

When Can You Expect A Response?

If the documentation review is being requested after the equipment has been delivered, CGS will respond in writing within 15 days. You will be notified that the documentation is either "supported" or "unsupported" and you will be provided with information about why the documentation didn't meet Medicare guidelines.

If the documentation review is being requested before the equipment has been delivered, CGS will attempt to respond with a phone call and a letter within 10 days.

If we receive your request and it is deemed "unsupported", you may provide further documentation and submit a subsequent request. The subsequent request must be received within 30 days of initial request. Please ensure that all supporting documentation is submitted with your subsequent request(s). For subsequent requests the "supported" or "unsupported" decision will be sent to you via letter.

Our CGS Connect™ program offers a broad range of benefits, including:

How Do You Get Started?

To request a professional pre-claim review of your documentation, simply complete the CGS Connect™ Request FormPDF located under the "forms" section of CGSMedicare.com. CGS Connect™ Request Form instructionsPDF and important fax information is included with the form.

Additional Information

Additional Education

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