Corporate

Provider Contact Center (PCC) Data

CMS requires all Medicare contractors to have a Provider Customer Service Program (PCSP) to assist providers in understanding and complying with Medicare's operational processes, policies, and billing procedures. A resource available to you to meet this requirement is the Provider Contact Center (PCC).

When contacting the PCC, please be sure you reach the correct department. Check here to avoid misrouted calls.

For your convenience, we track the top reasons you call us and post the answers on our Frequently Asked Questions (FAQs) webpage. If you have a question, save yourself some time and check the FAQs first!

Below is a list of the top reasons providers contacted us.

Top 5 Telephone Inquiries: August 2019

Reason Resource/Reference

Provider Enrollment: Provider Enrollment Requirements

Everything regarding credentialing is available to you on Provider Enrollment webpage!

Claim Denials: Claim Overlap

Medicare often receives multiple claims for the same patient with the same or similar dates of service. An overlap occurs when the date of service or billing period of one claim seems to conflict with the date on another claim, indicating that one of the claims may be incorrect.

  • Verify patient status using the Eligibility tab in myCGSPDF
    • The INPATIENT sub-tab allows you to enter a date span to determine whether patient was admitted to a hospital or skilled nursing facility (SNF)
    • The HOSPICE/HOME HEALTH sub-tab provides information on each election period (Hospice) and episode start and end dates (Home Health) based on the date span entered
    • NOTE: Information on inpatient status is available only after Part A and/or Home Health and Hospice claims have been submitted and captured by the Common Working File (CWF)
  • Verify the place of service code submitted on claims, as this could generate rejections (e.g., submitting place of service Office (11) when patient is inpatient hospital (21)

Global Surgery guidelines may also cause overlap issues.

  • Access the CMS Medicare Physician Fee Schedule Database (MPFSDB) Look-up ToolExternal website to determine the number of post-op days assigned to surgical procedures
  • Use the correct global surgery modifiers when it is appropriate to bypass edits in the processing system
    • The Modifier Finder Tool can help you determine whether CPT modifier 24, 25, or 57 (for E/M services) is appropriate; or if CPT modifier 78 or 79 (for procedures) will help. 
    • The medical record must support the use of any modifier

Claim Denials: Medicare Secondary Payer (MSP)

When Medicare is secondary, the primary payer must be billed first

  • Check this article for steps to help you with MSP claims
  • Refer to the MSP Job AidPDF to determine how a patient's record "should" appear
    • If the patient's record is different than what the flowchart suggests, please contact the Benefits Coordination and Recovery Center (BCRC)
  • Verify patient eligibility to determine whether there is a payer primary to Medicare

Claim Denials: Coding Errors/Modifiers

Call center staff cannot choose modifiers for you, as they do not have access to your medical records to ensure correct documentation is present

  • Utilize the Modifier Finder Tool for help with correctly selecting and using modifiers
  • Please be sure the documentation in the patient's medical record supports the use of any modifier added to a claim
  • For additional information, view the recorded webinar, "Appropriate Use of ModifiersExternal website" to learn more about the most commonly used modifiers

General Information: Misrouted Telephone Calls

Check the J15 Part B Contact Information page to locate the correct phone numbers and mailing addresses

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