DME
MAC Jurisdiction C Frequently Asked Questions (FAQs)
On January 16, 2007, The Centers for Medicare & Medicaid Services (CMS) awarded CIGNA Government Services, Nashville, Tennessee, the DME MAC contract for Jurisdiction C. Award of the contract will require CIGNA Government Services to implement and perform all contract functions for DME MAC in Jurisdiction C.
Current FAQs - Updated 03.28.08
Archived FAQs
National Provider Identifier (NPI) / Enrollment
Question: Why is my NSC number listed as an organization?
Answer: The records with the NSC are registered based on the information included in the enrollment application (CMS 855-S). If any information on file with the NSC is incorrect, a new CMS 855-S form must be submitted to the NSC to get the records updated.
Question: Why isn’t my NPI cross walking?
Answer: There are several reasons that may cause NPI crosswalk mismatches. Please visit the new CIGNA Government Services Jurisdiction C NPI Information Center on our website for guidance on correcting NPI errors at: www.cignagovernmentservices.com (DME MAC Jurisdiction C and click the red banner titled New DME NPI Information Center).
Claim Submission
Question: Why am I suddenly getting paper checks?
Answer: CMS provided a temporary waiver for Jurisdiction C suppliers to continue receiving electronic payments based on the Electronic Funds Transfer (EFT) Authorization form with the previous contractor. All Jurisdiction C suppliers have been notified to complete a new Electronic Funds Transfer (EFT) Authorization form identifying CIGNA Government Services as their contractor. The waiver expired February 15, 2008 and all suppliers without a valid EFT Authorization on file were converted to paper checks. To resume EFT, please complete a new CMS-588 form authorizing CIGNA Government Services to continue electronic payments.
Question: Why is my M&S being denied? Your office has confirmed 15 months of rental on my claim records?
Answer: Generally, if 15 rentals have been paid and M&S claims are denying, one or more claim payments have been recouped; the recoupment is often due to beneficiary’s enrollment in a SNF, Medicare Advantage Plan, Hospice, etc. If any rental payments have been recouped, the capped rental is not complete. The supplier may request an extension of the capped rental and bill the remaining months. M&S claims may begin again after six months from the fifteenth month rental payment.
Question: What should be included on a repair claim?
Answer: Repair claims must include at least:
- HCPCS code and date of purchase for item being repaired,
- Manufacturer’s name,
- Product name and model number,
- MSRP of item provided, and
- HCPCS code(s) for additional items added as part of repair
Question: How do I fit all the information needed in the narrative?
Answer: Information may be entered in the electronic claim narrative at a claim level and at a claim line level. We recommend using common abbreviations and brief comments.
Question: Why are claims for accessories denying for no record of the base equipment when the equipment is on file?
Answer: Be sure the accessories being billed are compatible with the equipment on file. If the claim was processed incorrectly, you may contact customer service for resolution.
Question: Why don’t our CMNs transmit properly?
Answer: The issue with the CMNs not loading is generally not a transmission issue. There are several issues that may cause CMN to reject; please review the CMN reject report to determine why a CMN rejected. The CMN reject report appears at the end of the electronic report package and lists claims with rejected CMNs. Rejected CMNs have a four-digit reject code. It is possible a claim will be accepted into our processing system but the CMN may be rejected. Some examples of the rejection reasons may include:
- The initial date for the CMN is prior to or the same as the end date on file for the same procedure code (Edit 3031).
- The recert or revision date for the CMN is prior to or the same as the revision or recert on file (Edit 3032).
- The recert or revision date is invalid (Edit 3047).
- The original CMN on file for this has been discontinued or closed so no recertification or revision may be accepted (Edits 3048 and 3052).
There are several options to correct the above errors:
- If the rentals are a continuation, please request that the capped rental period be extended for the remaining months to pay. For oxygen, obtain the recertification CMN with the appropriate date and resubmit the claim with the recert.
- If there is a break in service, please include the initial date, the pick up date, the redelivery date, and reason for break in the claim narrative. Be sure to include a copy of the new CMN/DIF if applicable.
- If the dates submitted were incorrect, resubmit the claims with the CMN, including the appropriate dates.
Question: Why do my claims deny same or similar against a piece of equipment that never paid?
Answer: If the patient had the same/similar equipment on file with Medicare, even if the claim was denied, there must be an explanation of what happened to the previous equipment before new equipment may be reimbursed by Medicare.
General
Question: Are there Spanish language services available?
Answer: Medicare beneficiaries requiring Spanish language may contact 1.800.MEDICARE. CMS does not currently require provider contact centers to provide translation services.
Question: Why do we require beneficiary consent to do same or similar calls; no other region requires this?
Answer: The CIGNA Government Services IVR (Interactive Voice Response System) began offering CMN Status as of March 20, 2008. This function is located under the Beneficiary Information (Option 2) and the CMN Status (Option 3). You must provide your PTAN, the beneficiary’s Medicare number, the beneficiary’s name and date of birth and the procedure code. This option will provide CMN information on file for a beneficiary for the procedure code entered. To check same or similar equipment, each HCPCS code in question must be entered separately.
