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CGS Administrators, LLC

IVR: 866.238.9650 Customer Service and myCGS: 866.270.4909

July 5, 2019

Prior Authorization and ADMC Request Submission Now Available in myCGS!

myCGS Version 5.5 has been installed, upgrading the web portal to include a great new feature—submission of Prior Authorization (PA) and Advanced Determination of Medicare Coverage (ADMC) requests!

myCGS is now a one-stop shop for PA and ADMC requests, whether you want to submit a new request or view the status of an existing request. In addition to adding the ability to submit requests, version 5.5 also includes an upgrade to the PA and ADMC status screens to allow you to view the decision letter for affirmed and non-affirmed cases.

The following is a brief overview of how the new PA and ADMC functionality works. Complete instructions will be available in the myCGS User ManualPDF soon. For information about PA and ADMC, refer to the DME MAC Jurisdiction C Supplier Manual, Chapter 9PDF.

  1. Accessing the PA and ADMC Screens

    All of the PA and ADMC functions are contained in the Claim Preparation menu in myCGS. Whereas previously there was only one menu option for both PA and ADMC status, there are now separate PA and ADMC menu options, each of which includes sub-menus for both Status and Form Submission. Use the Claim Preparation menu to access the screen you wish to use.

    Screen SHot

  2. Viewing PA and ADMC Status

    To view the status of an existing PA or ADMC request, choose the appropriate Status screen from the Claim Preparation menu and then perform a search just like in previous versions of myCGS. The PA and ADMC status results screen will look very similar to the old status screen, but now contains a "Documents" field. Press the View link in the Documents field to view a copy of the PA or ADMC decision letter. A popup window will display, where you can click on the "Download" icon to view, print, or save the letter.

    Screen Shot

  3. Submitting a PA or ADMC Request

    To submit a new PA or ADMC request, choose the Form Submission option under either Prior Auth or ADMC (whichever is appropriate) in the Claim Preparation menu. Once on the Submission screen, follow these steps:

    1. Complete the first part of the PA or ADMC submission form by entering the beneficiary’s Medicare ID, last name, first name, date of birth, and the HCPCS code from the detailed product description (your NPI and PTAN are automatically populated—be sure that you have the correct one selected). Press Submit.

      Screen Shot

    2. myCGS will validate the beneficiary information and HCPCS code, and then take you to the PA or ADMC Coversheet screen.

      Screen Shot

    3. Complete all of the appropriate fields on the Coversheet screen, including the physician’s information.
    4. Upload all of your appropriate/required documentation to support your request. To do so, press the Upload button, which will open up a navigation window for you to select the files you need to attach and submit to CGS.
    5. After selecting your files, press the Submit button. A popup message will appear, asking if you have attached all of your documentation. If you are ready to submit, press Yes.

Once submitted, we will process your request just like we would any other PA/ADMC submission. You can check the status of your request on the PA or ADMC status screen. Please note that it takes up to three business days before you will be able to view the status of your submission in myCGS.

We’re excited about these new myCGS features, and we think you will be too! Be sure to stay tuned to our ListServ and News page for additional myCGS news.

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