License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association website.
Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.

Financial Tools

Immediate Offset (eOffset)

myCGS allows you to submit an electronic authorization allowing us to offset funds to satisfy a pending overpayment due using an electronic eOffset Request Form. This authorization may be submitted each time a demanded overpayment is received or authorizes a permanent request for all future demanded overpayments. You may also monitor the status of the requests submitted through myCGS.

To access the form, select eOffset from the "Select a Form" drop-down. The eOffset page will display. It provides an explanation of the process and critical timeframes. There is also an option to select one of three eOffset forms
Provider Level Offset: This option allows you to establish immediate offsets for any current and future overpayments.
Demand Letter Offset: This option is selected if you have received a demand letter from CGS requesting an overpayment be returned and you would like to request a one-time offset.
Stop Provider Level Previously Requested: Select this option to stop automatic offsets for future overpayments.

Once you select an option and click "Submit" a disclaimer box will display to confirm timeframes and to ensure you have selected the correct form.

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Provider Level Offset

After accepting the disclaimer, the Provider Level Offset form will display. Most fields will show pre-populated with information based on your provider and user ID. Complete the remaining fields.

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After completing the required fields, click Submit to send the request for automatic offset for future overpayments.

An 'e-signature' box will appear, asking you to verify that the information entered is correct. This ensures thesignature requirement for all requests have been met. Click OK if you agree or Cancel to return to the form to make changes/corrections.

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After submitting the form, you will be taken to the Message tab. Shortly after submission, you will receive a confirmation message acknowledging receipt of the eOffset request. A separate message will be sent to your inbox which will include a Submission ID assigned to your request. This ID may be used to check the status of your submission.

Demand Level Offset

When selecting the option for a one-time immediate offset, a window will display allowing you to submit your request based on either the offset letter you received from CGS, or up to ten Accounts Receivable (AR) numbers identified on an attachment to the demand letter.

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Letter Option

Selecting the Letter option allows you to enter the number located in the upper-right header area of the demand letter to request the immediate offset.

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The Letter option form will display pre-populated with information based on your provider and user ID. You must complete the remaining fields.

When you enter the Letter number please verify that it is correct, as the field for the date of the overpayment letter will auto-populate.

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If the letter number entered is not correct, the date to respond has passed, or if the demand has been satisfied, an error message will display.

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After completing the required fields, click Submit to send the request for one-time offset An 'e-signature' box will appear, asking you to verify that the information entered is correct. This ensures the signature requirement for all requests have been met. Click OK if you agree or Cancel to return to the form to make changes/corrections.

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AR Option:

Selecting the AR option allows you to request a one-time immediate offset using the Accounts Receivable number assigned to the request.

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Using the AR option, you may enter up to ten AR numbers, which are identified on an attachment to the demand letter.

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The form will display pre-populated with information based on your provider and user ID. You must complete the remaining fields.

When you enter the AR number, please verify that it is correct, as fields for the date of the overpayment letter and overpaid amount will auto-populate.

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Once all fields are completed, click the Add AR Details button. All information will be added to the form. Enter additional ARs if submitting a request for more than one AR under the PTAN/NPI. Up to ten ARs may be entered on the same form.

After entering all ARs and the name of the person authorized to make the one-time immediate offset request, click Submit.

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Next, a message box will ask if you have additional ARs to enter. If so, press ADD. myCGS will submit the ARs you entered, then take you back to the form to enter more. If there are no additional ARs to be entered, press SUBMIT.

Stop Provider Level Offset Previously Requested

This form is to be used when you've previously submitted the Provider Level Offset form to authorize the immediate offset of all future demands but would now like to cancel that request.
After accepting the disclaimer, the Stop Provider Level Offset form will display. Most fields will show pre-populated with information based on your provider and user ID. Complete the remaining fields.

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Verify information entered is correct. Click Submit to send the request.
An 'e-signature' box will appear, asking you to verify that the information entered is correct. This ensures thesignature requirement for all requests have been met. Click OK if you agree or Cancel to return to the form to make changes/corrections.

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