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J15 Part A Customer Service Guide

Phone: 866.590.6703

  • Option 1: Claims
  • Option 2: Electronic Data Interchange (EDI)
  • Option 3: Provider Enrollment (PE)
  • Option 4: Overpayment Recovery (OPR)
  • Option 9: General Inquiries

Hours of Operation

When you call Customer Service, you’ll reach the Computer Telephony Integration (CTI) system.

What Is CTI?

CTI is an automated phone system that:

  • Requires you to respond to prompts by keying information on your telephone keypad.
  • Validates each keyed response before you reach a customer service representative (CSR).

Why Use CTI?

We use CTI to:

  • Authenticate Medicare providers.
  • Verify Medicare beneficiaries.
  • Only disclose personally identifiable information (PII) or protected health information (PHI) about beneficiaries (living or deceased) to authenticated Medicare providers.

In other words, we make sure callers are who they claim to be and are authorized to receive the requested information to treat, bill, and receive payment for services provided to Medicare beneficiaries.

Benefits of CTI

CTI allows you to:

  • Provide certain required data elements while on hold.
  • Receive immediate assistance once you’re transferred to a CSR.
  • Save time spent on the phone.

Required Data Elements

If you select option 1 (Claims) or option 4 (OPR), the CTI system will:

  • Prompt you to key the information below on your telephone keypad.
  • Verify each keyed response matches the information we have on file.
Provider Information Beneficiary Information
National Provider Identifier (NPI) Medicare Beneficiary Identifier (MBI)
Provider Transaction Access Number (PTAN) First name (first letter)
Tax Identification Number (TIN) (last 5 digits) Last name (first 6 letters)
Date of birth

Important: To protect beneficiaries and providers from Medicare fraud, we can’t release this information under any circumstances.

Before You Call

  • Gather all required data elements.
  • Verify the provider numbers are valid and active.
  • Ask the patient or representative for the beneficiary’s most recent Medicare card. MBIs may change and the name you enter must be an exact match.
  • Use the MBI Name & Number Converter to get the correct numbers to enter on your telephone keypad.

General Inquiries

If you select option 9 (General Inquiries), you don’t need to enter any data elements. Use this option for questions that don’t involve a specific beneficiary or claim, such as:

  • Does Medicare cover services furnished outside of the U.S.?
  • How long does Medicare allow providers to submit a claim?
  • How can I get Medicare forms?
  • Where can I find information on the CGS or CMS website?

Beneficiary Eligibility

You must use one of these self-service options to obtain beneficiary eligibility information:

CSRs can’t provide this information and must refer callers to these systems (unless a technical issue is confirmed).

Claim Status

You must use one of these self-service options to obtain claim status:

CSRs can’t provide this information and must refer callers to these systems. However, you may reach out to Customer Service if you have additional questions after you determine the claim’s status.

Additional Resources

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