Instructions for mycgs Part B Self-Service Reopenings

Transcription

1 Instructions for mycgs Part B Self-Service Reopenings Part B providers can now correct the header diagnosis and the detailed line diagnosis clerical errors themselves from mycgs. You can now access your claim information to make the header diagnosis and the detailed line diagnosis correction/changes yourself, just by following these instructions. Reopening requests must be submitted within 12 months of the original claim remittance date. 1. Enter your user ID and password in the appropriate fields, then click Submit 2. Select Form: 3. Select a Topic - Appeals Page 1 April 5, Copyright, CGS Administrators, LLC.

2 4. Select a Type Reopenings 5. Click on Reopenings: ER J15-B-1000 link a. Once you click on the Reopenings Part B: ER-J15 B-1000, the mycgs Reopenings Request page will appear. This page explains timeframes and provides examples of valid Reopening requests. These details must be considered prior to submitting a request. 6. Select Single Beneficiary. 7. SINGLE BENEFICIARY REOPENING FORM There are four sections to the form: 1.) Provider Information; 2.) Beneficiary Information; 3.) Claims Information; and 4.) Supporting Documentation. Each field marked with a RED asterisk is a required field. Provider Information Section You must complete the following fields: Provider Address 1 Provider Phone Number Provider City Provider Zip Code Provider State Last 5 Digits of Tax ID National Provider Identifier (NPI) Page 2 April 5, Copyright, CGS Administrators, LLC.

3 Beneficiary Information Section Beneficiary Name Medicare ID 8. Claim Information Section Claim ICN This is the internal control number (ICN) of the original claim. The ICN can be located on your remittance advice. Type Drop down box - Identifies the type of reopening you will be requesting Single Beneficiary Diagnosis code submissions: 1.) Header Diagnosis Add/Replace/Remove 2.) Line detail Diagnosis coding Add/Replace/Remove These are separated out into two sections. Header Diagnosis Reminder: Documentation is not reviewed for a header diagnosis- add, replace, or remove correction. The reopening department will only handle a simple correction, as outlined in the steps below. Documentation, including 1500 claim forms, is not needed for diagnosis- add, replace, or remove corrections. 1.) Select the Type of Adjustment Header Diagnosis Code. 2.) Select the Action for the Header Diagnosis Code: Add, Remove, or Replace. 3.) For Header Diagnosis code, the LINE is not used. This code will be applied to the Header only. Reminder: If you need to update the Line Diagnosis Code, as well as the header, you will need to do this in a separate step on this form (see below for Line Diagnosis Code). Page 3 April 5, Copyright, CGS Administrators, LLC.

4 4.) Select the Position. In the header, there are 12 positions from which to choose. You should always add headers to the next available space. You can remove or Replace headers from any space which already has a value present. 5.) Enter the 3-7 digit diagnosis code that needs to be added, replaced, or removed in the New Value field. Note: At present, when the option Remove is selected the New Value field is locked. An enhancement is coming which will require that the New Value field be entered with the 3-7 digit diagnosis code which is being removed. This will increase accuracy so that only the requested diagnosis code is removed. 6.) Press the Add Button. Action is added to the grid once you click on add button. If an error was made, to remove this specific line of a correction, click the red x under DELETE field (see above). If an error was not made the upload of any medical documentation can be bypassed, medical documentation (including a 1500 claim form) is not required for diagnosis code-add, replace, or remove. Then enter the name/signature of the person completing the form, and click submit. Up to 13 corrections can be made on the Single Beneficiary form. If additional corrections are needed, simple select the correct Type, Action, Line (if applicable), Position, and New Value fields and Add. The second corrections will appear on the grid. Corrections 2-13 do not have to be the same type of correction (i.e., you can have a header diagnosis code/line diagnosis code, a procedure code/billed amount/ header diagnosis code, a modifier/line diagnosis code, as well as a header diagnosis code/header diagnosis code). Please note some types of multiple corrections (i.e. diagnosis code/modifier) may not be eligible to automate, and will fall within the 60 days completion for a Reopening request allowed by the Centers for Medicare and Medicaid Services. 7.) Below the Attachments section is the Submitters Name field. The first and last name of the person completing the form must be entered into the submitter s name field, before selecting the Submit button. Page 4 April 5, Copyright, CGS Administrators, LLC.

5 Line Diagnosis Reminder: Documentation is not reviewed for the line diagnosis- add, replace, or remove correction. The reopening department will only handle a simple correction, as outlined in the steps below. Documentation, including 1500 claim forms, is not needed for diagnosisadd, replace, or remove corrections. 1.) Select the Type of Adjustment Line Diagnosis Pointer 2.) Select the Action for the Line Diagnosis Pointer: Add, Remove, or Replace Note: If selecting Add or Replace, the new diagnosis code to reference on the line diagnosis pointer must be present in the header. Example: Adding Line Diagnosis Pointer I10, make sure that diagnosis code I10 is also present in the header. If this is not present, you will need to add it to the header using the Header Diagnosis Code type in order to add or replace it as a Line Diagnosis Pointer. 3.) Select the Line on which to correct the Line Diagnosis Pointer. Please use your remittance for the specified claim to determine the line number. 4.) Select the Position to add the Line Diagnosis Pointer. There are 4 positions available, and any of the header diagnosis codes can be referenced in these positions, in any order. Page 5 April 5, Copyright, CGS Administrators, LLC.

6 Reminder: Make sure the Line Diagnosis Pointer used is also present in the header. Example: Line Diagnosis Pointer is going to be diagnosis code I10, make sure that diagnosis code I10 is also present in the header. If this is not present, you will need to add it to the header using the Header Diagnosis Code type in order to add or replace it as a Line Diagnosis Pointer. 5.) Enter the 3-7 digit diagnosis code that needs to be added, replaced, or removed in the New Value field. Note: At present, when the option Remove is selected the New Value field is locked. An enhancement is coming which will require that the New Value field be entered with the 3-7 digit diagnosis code which is being removed. This will increase accuracy so that only the requested diagnosis code is removed. 6.) Press the Add Button. Action is added to the grid once you click on add button. If an error was made, to remove this specific line of a correction, click the red x under DELETE field (see above). If an error was not made the upload of any medical documentation can be bypassed, medical documentation (including a 1500 claim form) is not required for diagnosis code-add, replace, or remove. Then enter the name/signature of the person completing the forms, and click submit. Up to 13 corrections can be made on the Single Beneficiary form. If additional corrections are needed, simple select the correct Type, Action, Line (if applicable), Position, and New Value fields and Add. The second corrections will appear on the grid. Corrections 2-13 do not have to be the same type of correction (i.e., you can have a header diagnosis code/line diagnosis code, a procedure code/billed amount/ header diagnosis code, a modifier/line diagnosis code, as well as a header diagnosis code/header diagnosis code). Please note some types of multiple corrections (i.e. diagnosis code/modifier) may not be eligible to automate, and will fall within the 60 days completion for a Reopening request allowed by the Centers for Medicare and Medicaid Services. 7.) Below the Attachments section is the Submitters Name field. The first and last name of the person completing the form must be entered into the submitter s name field, before selecting the Submit button. Page 6 April 5, Copyright, CGS Administrators, LLC.