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June 6, 2019

myCGS Enhancement: Part A Claims Practice Addresses

As of June 1, 2019, Part A Outpatient Prospective Payment System (OPPS) hospital providers are able to use the myCGS Portal to confirm that the practice addresses submitted on their claims are an exact match to PECOS to help avoid/correct any Return to Provider (RTP) claims.

Background

Per the CMS MLN Matters article SE19007External PDF, “Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations”, once the July 2019 Quarterly release is implemented, CMS will direct A/B MACs to permanently turn on two system edits to enforce the requirements in the CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 1External PDF, section 170:

  • Reason Code 34977 (claim service facility address doesn’t match provider practice file address)
  • Reason Code 34978 (Off-campus provider claim line that contains a HCPCS must have a PN or PO)

In 2018, CMS performed two rounds of national testing of these edits, and determined that many providers are not sending the correct exact service facility location on the claim that produces an exact match with the Medicare enrolled location as based on the information entered into the PECOS for their off-campus provider departments.

myCGS Instructions

To access the practice addresses associated with your account:

Step 1: Once you are logged in to myCGS, select the Claims tab.

Step 2: Select the Practice Addresses tab.

Step 3: A list of addresses associated with your NPI and PTAN will appear in the same format as PECOS. Ensure the service location address reported on your claim is an exact match.

Note: The Practice Addresses information is updated on a weekly basis. Please allow up to 10 business days after you receive confirmation for a new/revised practice location address to become available in myCGS.

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Take advantage of this enhancement and other features by registering for myCGS!

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