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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: June 2020

Reason Resource/Reference

Provider Enrollment: Not Classified

When submitting inquiries, it is important that you include information needed to authenticate yourself, as this is a requirement of the Centers for Medicare & Medicaid Services (CMS). The data elements required to do this include:

  • Your National Provider Identifier (NPI);
  • Your Provider Transaction Access Number (PTAN);
    • Be sure to use the Group PTAN (when applicable). Individual PTANs are not used in the privacy verification process when a Group PTAN is assigned to the provider.
  • The last 5-digits of your tax identification number (TIN).

Everything regarding credentialing is available to you on Provider Enrollmentwebpage!

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, "Avoid Modifier Rejections!External Website" to learn more about the most commonly used modifiers

Claim Denials: Not Classified

Refer to the Claims webpage for resources specific to Part B claims

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

General Information: References/Resources

Rely on the CGS web site Search Engine to locate articles to address a number of issues

Refer to the Browse by Specialty and Browse by Topic webpages for resources on specific topics

Refer to our COVID-19 webpage for information specific to the Coronavirus

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