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CGS Administrators, LLC

IVR: 866.238.9650 Customer Service and myCGS: 866.270.4909

February 4, 2019 - Updated 03.06.19

CGS Listens! Announcing Process Improvements

2018 was a very busy year for CGS! We have been taking action, implementing new tools and processes and enhancing the services we offer to you. There are a variety of ways for you to provide your feedback to us on specific services, including the web site survey. We sincerely appreciate your responses and thoroughly review every survey that we receive. These surveys allow us to capture your feedback immediately and are reviewed frequently. However, there is one survey that is only presented once per year and serves a special purpose: The Medicare Satisfaction Indicator (MSI) Survey.

CMS administers the MSI Survey each year to objectively measure our services, and help us gain important insights about you and what specifically drives your satisfaction. We carefully review the results of this survey and below are some the actions that we have taken as a result of your feedback in 2018:

Provider Outreach and Education
  • Suppliers continue to ask for more detail in Local Coverage Determination education, including more complex scenarios. To help increase supplier knowledge, reduce billing errors and address more complex billing issues, LiveLine Plus webinars are being scheduled in 2019. These webinars focus on errors and trends identified in specific policies and provide more time and opportunity for questions. These webinars are provided in conjunction with a policy-specific webinar and scheduled during the same week to allow detailed, policy specific education followed by a more in-depth question and answer session. View the current webinar schedule on the DME MAC POE Calendar of Events web page.
Provider Self-Service
  • One of the most frequent calls to our customer service center is for additional information regarding a claim denial. We understand it can be frustrating to find additional information about what a denial may mean, or how to correct it, when the ANSI denial message is vague or confusing. To help alleviate the need to call, we created the Claim Denial Resolution Tool. Just enter the Reason Code and/or Remark Code from your Remittance Advice and receive more details about the possible causes, as well as how to resolve the issue. Since the tool was introduced on our website in October 2018, it has received more than 21,000 visits with usage increasing monthly, saving suppliers time and effort in calls to customer service.
  • We created the Medicare Beneficiary Identifier (MBI) Converter tool to make it easier for you to use the Interactive Voice Response (IVR) system. The new MBI format can result in the need to enter between 19-23 characters on the telephone keypad. The converter will come in handy if you are using the IVR to verify the beneficiary's information based on the new Medicare Card. Simply enter the MBI and the tool will convert the numbers for you.
Medical Review
  • CGS recognizes that obtaining documentation from the treating physician/prescriber is a major issue, and we have been able to successfully partner with many A/B MACs and provide education about medical necessity documentation directly to physicians, practitioners, and/or their staff.
  • Proficiency reviews and additional training has also been implemented to improve the quality of medical review decisions and decrease the need to appeal claims. We have also implemented a process to internally review and discuss case studies to ensure consistent decision results and identify additional training needs.
  • Targeted Probe and Educate (TPE) was rolled out in 2017, and we have been hearing that you want to know about denial trends and issues that are a result of this relatively new audit strategy. Quarterly status reports on Medical Review's current service-specific pre-payment reviews are now published on our web site. You may review these reports for detailed information by policy group to see the claims payment error rates and top claim denial reasons for each product category. The reports are available on the Quarterly Reports web page.
Redeterminations (Appeals)
  • Customer service representatives are receiving additional training to ensure they have the latest information regarding the appeals process and any issues affecting redeterminations. This monthly training is helping to increase customer service knowledge and ability to quickly locate information regarding specific appeal and reopening requests.
Website Search Enhancements:
  • Auto Complete – When you type in the search box, results automatically appear below the search field as you are typing. You can either select one of the suggested search results, or complete your search phrase and click the magnifying glass next to the search box for a list of Search Results.
  • Misspelled words – Even if you misspell a word, the search engine will let you know the results for the correctly spelled word. For example, if you mistype "clam", you will receive a message "Your search for "clam" returned no results. Showing results for "claim".
  • No results – If there are no results for your search term, we will let you know there are no results and will provide options to help you find what you are looking for. View additional search tips to help you find exactly what you are looking for.

These are just some of the improvements that we are making as a result of your willingness to share your opinions with us.

Watch for upcoming announcements on our web site and in our ListServs for the 2019 MSI Survey. We look forward to hearing your feedback about how we are doing and any other suggestions you may have on how we can improve our services!

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