February 2, 2023
New Authentication Requirement When Calling the Provider Contact Center – Effective May 1st
To protect the privacy of Medicare beneficiaries and providers, Medicare Administrative Contractors (MACs), like CGS, are required to authenticate certain elements before releasing beneficiary-specific information.
Claim-specific/eligibility questions require you to authenticate the following elements using our Computer Telephony Integration (CTI) system:
- Provider National Provider Identifier (NPI),
- Provider Transaction Access Number (PTAN),
- The last five digits of the provider Tax Identification Number (TIN).
- Beneficiary’s Medicare Beneficiary Identifier,
- The first six letters of the beneficiary’s last name,
- The first letter of the beneficiary’s first name, and
- The beneficiary’s date of birth.
Beginning May 1, 2023, claim- and eligibility-specific calls received in the Provider Contact Center (PCC) that are not properly authenticated will be transferred back to the CTI line to complete this required step.
General questions do not require authentication. These are calls that do not require the CSR to access the claims processing system Fiscal Intermediary Standard System (FISS) for Medicare Part A or the Common Working File (CWF). Claims specific questions are those that do require the CSR to access FISS or CWF.
NOTE: General questions about a beneficiary’s Medicare eligibility and claim status can often be answered through the Interactive Voice Response (IVR) system and myCGS, the CGS Web Portal. CSRs will refer providers back to the IVR if they have eligibility or claim status questions. However, CSRs may be able to assist with more detailed eligibility questions pertaining to Medicare Secondary Payer (MSP), Health Maintenance Organizations (HMOs), etc.
Please refer to the following table as a guide in determining if your question is claim-specific or general.
Claim Specific Question |
General Question |
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Use the Medicare Beneficiary Identifier (MBI) and Name to Number Converter Tool to convert letters to numbers (and the *) for easy entry using your telephone keypad. A few tips:
- Be sure to enter ALL characters as displayed in the tool.
- Pay extra attention to the *, as it lets the IVR/CTI know you are entering a letter.
- For example, the letter Q is entered as *11.
- When calling the CGS PCC, make sure you are using the CGS converter tool.
- Other contractors may have a comparable tool that does not work with our IVR/CTI.