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LICENSES AND NOTICES

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA websiteExternal Website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association websiteExternal Website.
  3. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
  4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
  5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.


Impact

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March 7, 2019

Process Improvements Based On Your 2018 MSI Survey Feedback!

Your voice was heard and appreciated. We made improvements within the past year in response to your comments in the 2018 Medicare Administrator Contractor (MAC) Satisfaction Indicator (MSI) Survey feedback results. Based on your feedback, CGS enhanced the following.

Appeals:

Audit & Reimbursement:

Claims

Medical Review (MR):

  • In an effort to assist providers with the Targeted Probe and Education Process as well as self-audit activity, two new Medical Review provider resource tools were posted the CGS website.
  • In response to provider feedback regarding clarity of reason for medically reviewed denied claims, Medical Review updated review results letters to provide more detailed denial rationale information.
  • Our goal is to ensure you receive the most benefit from your medical review educational experience. That's why CGS's Medical Review educators updated processes in order to provide clear and consistent information, offering resources and tools, and answering and following up on provider questions.
  • You asked for more web based educational opportunities! Check out the recorded webinars on our website for many clinical educational opportunities including Additional Development Request (ADR) tips and specialties such as Chiropractic, Ambulance, and Podiatry! And stay tuned for more…
  • Here's all you need in order to always know the date you need to submit your Additional Development Request (ADR) documentation. Access the Additional Development Request Timeliness Calculator and determine the date your documentation must be received by CGS.

myCGS Web Portal:

CGS is continually working to enhance our provider web portal based on your feedback. Here are a few of our recent enhancements.

  • Additional functions were added to the Claim Status page that allows you to:
    • Submit a Redetermination (1st level of appeal)
    • Request a Part B Reopening of the claim
    • Respond to a request for additional documentation
    • View CARC and RARC Codes and definitions
    • Ask questions regarding the claim
  • The Medical Review (MR) Dashboard was developed to quickly identify MR additional documentation requests (ADRs). Under the Medical Review tab, review the ADR status, select a claim number to receive detailed claim information beginning at the point of the ADR pending to the medical review status, outcome, and allowing you to request a redetermination (1st level of appeal).
  • The Eligibility tab was enhanced to allow immediate access to your patient's history to see if Medicare Diabetes Prevention Program (MDPP) services were provided and helps you determine the next available date for certain MDPP services.
  • The Eligibility tab was enhanced to allow access to diagnosis codes associated with Medicare Secondary Payer (MSP) insurance type such as worker's compensation, automobile, and liability situations.
  • A new myCGS STATUS button was added to the top right of the Part A, Part B, and HHH website. When the myCGS STATUS button shows green, the web portal is up and running normally, yellow means there's an issue with some aspect of myCGS and when it shows as red, the myCGS web portal is not functional. Simply click on the button to access details of the issue.

Access the December 19, 2018, myCGS Enhancements WebinarExternal Website recording for additional information.

Provider Contact Center (PCC):

  • No more searching for our contact number! For easy access, we made the telephone numbers to the PCC and to call the Interactive Voice Response (IVR) system available on the top of every Web page.
  • We know the new Medicare Beneficiary Identifier (MBI) format can be difficult to enter when using the Interactive Voice Response (IVR) or the Computer Telephone Integration (CTI). Therefore, we created the IVR and CTI Converter Tools which converts the beneficiary's name and Medicare number for easy entry on your telephone keypad.
  • In addition to the monthly PCC trainings set aside for our customer service representatives (CSRs), we continually review the top 10 telephone inquiries and have update internal tools to improve CSR consistency and 1st call resolution to better serve you.

Provider Enrollment:

CGS is continually strives to make the provider enrollment process a smooth process for providers. Therefore, we have focused on our communication to you and developed educational tools and resources.

Provider Outreach and Education (POE):

  • Have you noticed our enhanced webinars and ask-the-contractor teleconferences? In order to answer questions on the spot, we have added operational area subject matter experts to our webinars! We also now give you the opportunity to ask questions when registering for an event. This has allowed us to ensure we include all information you feel is important and have answers ready!
  • If you frequently visit our Calendar of Events web page, you may have noticed that we have significantly increased our educational events offerings! We heard your feedback, and we are out and about! Make sure you stay up to date on where we will be next or what webinar topic we have coming…
  • Did you miss an event?? Don't worry! We have recorded and posted many of our previous webinars! Check them out at the top of the Calendar of Events page!
  • We are constantly enhancing our search engine in order to provide you the best results! In the past year, some of our enhancements included a language prediction tool that provides suggestions as you type in a search term, search misspelled words, a no results message and search tips to help you find exactly what you are looking for.

Coming Soon: 2019 MAC Satisfaction Indicator (MSI)

If you liked these changes recently made or have more to suggest, let us know!! It is because of your feedback that we were able to accomplish these improvements. The 2019 MAC MSI survey is coming in March and this is the best opportunity to share your opinion with CGS and CMS! Be on the lookout for the survey in the next few days!

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