A Deeper Dive Into myCGS Ask the Contractor Teleconference
June 11, 2020
These questions were either pre-submitted or asked during the teleconference.
Click on a question to expand or Show All / Close All
- Potentially I would like to know what the information on page 1 of the eligibility sheet means.
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Part A and Part B Effective Dates/ Termination Dates (if applicable), Inactive Periods (time frame bene does not have Medicare coverage), Bene's Demographics, and End Stage Renal Disease information displays on page 1 of Eligibility Tab.
Published: 06.22.20
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- Can we use My CGS for PECOS or Timeliness Reopenings?
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At this time myCGS can not be used in conjunction with PECOS. Reopenings: currently, there is not an option for Timeliness Reopenings.
Published: 06.22.20
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- Where can I find which Medicare Advantage insurance a beneficiary has?
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Medicare Advantage Plans and HMO data can be located in myCGS on the Eligibility Tab and select Plan Coverage.
Published: 06.22.20
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- Where can I find the appeal decision letters in the program/portal?
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For Redeterminations, if the appeal is fully favorable, you will find the adjustment also on your Remittance Advice (RA), so no letter is generated. If the Redetermination decision is partially favorable or unfavorable, we will issue a letter of explanation (greenmail), which will be delivered to your Messages Inbox. If you do not have access to this information, please check with your office Provider Administrator for assistance.
Published: 06.22.20
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- Why is an Additional Documentation/Development Request (ADR) generated and when the agency responds, why is the response never (it seems) accepted?
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ADRs are generated for additional information that may help the Medicare Administrative Contractor (MAC) correctly adjudicate the provider's claim. Once the provider responds with the appropriate documentation, the claim and documentation are reviewed by the applicable department. They will render a decision based off the documentation received.
Published: 06.22.20
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- Can you go over quickly what the screens of the eligibility mean and how to understand what I am looking at?
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The Eligibility Tab and its offerings were highlighted during the ACT. Please also review Chapter 4 of the myCGS User Manual, /mycgs/mycgs_user_manual.html.
Published: 06.22.20
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- I am unable to print or download the handouts could you please email them to me?
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Copy of the handouts mailed to participants.
Published: 06.22.20
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- Is the issue of seeing the appeal status known to Medicare? We have not been able to see status all week. I can see where the appeal status is, but it says it cannot be seen at this time.
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When you say Appeals status, are you referring to the Appeals window available to Part A and HHH providers as noted on slide 21? We are unaware of this issue, but we will reach out to the provider to research.
Published: 06.22.20
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- What is the difference between a reopening vs just sending additional claim with the added modifier for example? We have had luck you just processing that additional claim.
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In some circumstances you can simply resubmit the claim if the original one was denied. If there was payment made on the original claim, however, and the modifier is required to avoid affecting future claims (such as global surgery situations,) a Reopening would be appropriate in order to make the adjustment. Resubmitting the claim in this situation would result in a duplicate denial.
Published: 06.22.20
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- I have a patient with dates of service from 2018. The Medicare advantage plan just took their payment back. I am unable to locate the patients Medicare number so that I can bill Medicare. The portal states it is too old. So, my question is how can I find the number and is this something that can be appealed with Medicare? It will deny as timely.
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If you have the patient's name, date of birth, social security number, you can use the MBI Look Up Tool to obtain the MBI. See slide 14 for details… Now, if the patient is deceased, CMS is going to make a change that will allow the look up tool to look further in history to provide you with the MBI. For dates of death that exceed 13 months but is less than 48 months, you may call the Provider Contact Center (PCC) for assistance from a customer service representative.
Published: 06.22.20
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- Is there a section on the portal that tells the dates of certain procedures for members? For example, last Pap?
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Yes, a preventive services screen is available under the Eligibility Tab.
Published: 06.22.20
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- We had an ALJ hearing in January and have not heard anything. Is there a way to check that on myCGS?
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Providing the appeals information is a project CMS is leading. We are aware they are considering ALJ status, as well. Once this is added to the portal, we will be sure to inform you via an email notification (listserv). No estimate on time frame at this point.
Published: 06.22.20
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- Can a denial question possibly be addressed/resolved in reopenings?
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Are you referring to Part B Reopenings? If so, questions are considered inquiries and not Reopenings. You can submit a question by clicking the "Ask a Question" button located on various myCGS pages. This button is just for general questions and not used to respond to ADRs or send documentation to add to claims.
Published: 06.22.20
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- I am logged into myCGS – claims – and only have claims tab?
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When other tabs are grayed out, this indicates you do not have authorization to perform that function. Check with your Provider Administrator for access.
Published: 06.22.20
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- I reviewed my access, and all looks good. We are using myCGS for our Hospice Part A and utilize Novitaspher for our Part B.
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If you're looking to the Practice Addresses screen, it is currently only available to Part A hospitals who operate outpatient off-campus provider-based departments.
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