Part
B Interactive Voice Response System
Attention: Please be aware that beginning Friday, May 23rd, 2008 providers will need their NPI and PTAN in order to utilize the IVR or when speaking to a Customer Service Representative.
On This Page:
You may access our IVR by calling the following toll-free telephone number:
| North Carolina Providers: | 866.238.9651 |
| Tennessee Providers: | 866.502.9056 |
| Idaho Providers: | 866.502.9051 |
The Centers for Medicare & Medicaid Services (CMS) requires providers to utilize the Interactive Voice Response (IVR) System to check the status of claims. The IVR is available during and outside normal customer service hours with allowances for system maintenance and mainframe availability. You can also order duplicate remittance notices, as well as obtain the Medicare Part B deductible status, allowable for procedure codes, denial reasons, outstanding check amounts, and other claim processing information.
When a claim has completed processing and is being held due to the payment floor, you will not be able to obtain claim detail until the remittance is issued. If you have a business need to receive this information before the remittance is issued, you may want to consider Claim Status Inquiry. Contact the EDI department at 1.866.352.1608 for NC providers, 1.866.520.4022 for TN or ID providers, or visit our Web site, EDI section at www.cignagovernmentservices.com for more information about Claim Status Inquiry.
CIGNA Government Services encourages providers to utilize the IVR as a resource so that our Customer Service staff will be available should you require dedicated assistance with issues that can not be resolved via the IVR.
CIGNA Government Services requires providers to use the IVR for simple transactions, such as eligibility and claims status. This allows our Customer Service Staff to be available when you need dedicated assistance for your complex issues. If your inquiry cannot be resolved through the IVR you may reach a customer service representative by calling 1.866.655.7996 in NC, 1.866.824.8572 for TN and 1.866.824.8593 for ID.
Steps in Using the Interactive Voice Response (IVR) System
Greeting:
"You have reached the Interactive Voice Response Access line for CIGNA Government Services Medicare Part B. To ensure excellent customer service, your call may be monitored or recorded for evaluation purposes."
TopMain Menu:
- Press "1" for claim status
- Press "2" for eligibility information
- Press "3" for the current years deductible or physical or occupational therapy limitations
- Press "4" for outstanding check and offset information
- Press "5" for other inquiries
- Press "6" for NPI and PTAN crosswalk validation.
- Press "7" to repeat information
- Press "0" for the customer service representative phone number
Provider Transaction Access Number (PTAN):
** TN and ID providers will be prompted to enter their PTAN followed by ‘#” **
NC providers will follow the prompts below:
- If your PTAN ends in one or more letters, press "1", otherwise press "2".
- After pressing "1":
- Your PTAN consists of a series of numbers followed by a letter.
- If your PTAN does not end in a letter, press "#" (pound).
- Enter the series of numbers followed by the "#" (pound) key.
- Enter the letter now. For instructions for entering a letter press "0", "0".
- If there is another letter press "1", otherwise press "2".
- Now enter the second letter,
- The PTAN will be repeated, press one to confirm.
Instructions for entering letters:
- To enter a letter, you will press two keys:
- First, press the key with the letter.
- Then press "1", "2", or "3" depending upon the position of the letter on that key.
- Example : To enter the letter A, press "2" then "1
On telephones where Q appears with P, R, and S on key 7 assume that R and S are the second and third positions respectively. Regardless of your telephone type, assume that Q and Z are on the one key. Q would be positioned as the first letter and Z as the second. - Example : To enter Z, press "1" then "2".
- Enter the letter at the end of your PTAN.
Patient's Medicare Number:
- Press "1" if the Medicare number ends in a letter or letter-number combination.
- Press "2" if the Medicare number begins with one or more letters.
- Enter the first 9 digits of the Medicare number.
- If the letter at the end of the Medicare number is:
A press "1" B press "2" C press "3" D press "4" M press "5" T press "6" W press "7" Any other letter press "0" for the customer service representative phone number. - If there is a number after the letter, press that number now.
- If there is nothing following the letter, press "#" pound key.
- If there is another letter following the letter,
press "*" star key.
- If the second letter is:
A press "1" B press "2" If it is any other letter, press "0" for the customer service representative phone number.
- If the second letter is:
Patient's Name:
- Enter the beneficiary’s first initial using the letters on your telephone keypad.
- Enter the first six digits of the beneficiary’s last name followed by the # key.
- Example 1: Smith will be “7”, “6”, “4”, “8”. “4”.
- Example 2: Smith Jr will be “7”, “6”, “4”, “8”, “4” “5”
Claim Status:
- Enter the date of service for this claim. Enter the date in a month-month, day-day, year-year format.
- Example : If the date of service is January 25, 2000 , enter "0", "1", "2", "5", "0", "0". Enter the date now.
Note :
- The system will give claim information in the following categories:
- Claim pending
- Applied to deductible
- Paid
- Denied
- The system only advises payment made to the provider.
- Non-assigned claim information will not be given.
- Press "1" for line-by-line information, otherwise press "2" to continue.
- After pressing "1" and line information is given for the first line, press "1" for the next line and for each line until you receive the message there are no more lines for this claim.
- Press "1" for a duplicate remit, otherwise press "2".
- After claim information and/or line-by-line information:
- Press "1" to check another claim with the same date of service.
- Press "2" to check for a claim with a different date of service.
- Press "3" to check on a claim for a different HICN.
- Press "7" to repeat the claim information
- Press "9" to get information about a different PTAN.
Eligibility Information:
- Enter the beneficiary’s 8 digit date of birth. Enter the date in a month-month, day-day, century-century, year-year format. (Example: November 01, 1933 enter “1”, “1. “0”. “1”. “1”. “9”, “3”, “3”)
- Enter the beneficiary’s gender, press "1" for male and "2" for female .
- Message:
"The most current records we have on file from the Social Security Administration show this beneficiary has Medicare Part A entitlement effective… and Part B entitlement effective…" - To verify if this beneficiary is enrolled in a Medicare HMO, press "1".
- You will receive one of the following messages:
- "According to our records there is no Medicare HMO information available for the Medicare Number you entered."
- "The most current records we have on file show this beneficiary is currently enrolled in a risk HMO beginning…."
- To verify Medicare Secondary Payer information for this beneficiary effective today, press “2”.
- You have chosen to check MSP information. The information given is the most current on record. Please note we will only verify disability, working aged and ESRD records and that the beneficiary is the best source for current MSP information. You will receive one of the following messages:
“Our records show Medicare is primary for this beneficiary.”
“Our records show Medicare may be secondary to another insurer. For more information contact the beneficiary.”
- You have chosen to check MSP information. The information given is the most current on record. Please note we will only verify disability, working aged and ESRD records and that the beneficiary is the best source for current MSP information. You will receive one of the following messages:
Deductible and Therapy Limitation Information:
- Enter the beneficiary’s 8 digit date of birth. Enter the date in a month-month, day-day, century-century, year-year format. (Example: November 01, 1933 enter “1”, “1. “0”. “1”. “1”. “9”, “3”, “3”)
- Press "1" for deductible.
- Message:
"The amount of deductible applied for the current calendar year is XX dollar(s) and XX cent(s )" - Press “2” for the physical therapy limitation.
- Message:
“The amount of physical therapy limitation applied for the current calendar year is XX dollar(s) and XX cent(s).
- Press “3” for the occupational therapy limitation.
- Message:
The amount of occupational therapy limitation applied for the current calendar year is XX dollar(s) and XX cent(s).
Outstanding Checks and Offset Information:
- Press "1" for outstanding checks released to your PTAN within the last month.
- After receiving information on the first outstanding check, press "1" for the next outstanding check.
- Press "1" to repeat all check information until you receive the message there are no more outstanding checks.
- Press “2” for offset claim detail information.
- You will be prompted to enter the FCN number. The FCN number is located on your Medicare payment report. The claim number, Medicare number, date of service, claim offset amount and patient account number will be given for up to 26 claims.
- Press “3” for offset letter date, interest accrued and offset balance.
- You will be prompted to enter the FCN number.
Other Inquiries:
- Press "1" for an allowable
- Press "2" to order a duplicate remittance notice
- Press "3" for appeal rights
Allowable Information:
- Press "1" for an Ambulance code.
- Press "2" if the procedure code begins with a letter.
- Press "3" for all other procedure codes.
Note:
For Ambulance code:
- Enter the zip code where the ambulance service originated.
- Press "1" if the procedure code begins with an A.
- Press "2" if the procedure code begins with a Q.
- Enter the 4 numbers that follow the prefix.
- If the type of service is a number, press "1".
- If it is a letter, press "2".
- Enter the type of service.
- Message:
"The current year allowed amount for this procedure code is _________."
Procedure Codes that Begin With a Letter:
- If the procedure begins with the letter:
A press "1" G press "2" J press "3" M press "4" Q press "5" R press "6" V press "7" E press "8" B press "9" D press "#" - Now enter the 4 numbers that follow the prefix.
Procedure Code Modifier and Type of Service:
- Press "1" if there is a modifier at the end of the procedure code.
- Press "2" for no modifier.
- Press 1 f or an alpha modifier
- Press 2 for a numeric modifier
Note:
Modifier:
AH press "1" AJ press "2" AS press "3" TC press "4" 26 press "5" 54 press "6" 55 press "7" 80 press "8" 78 press "9"
- Now enter the type of service
- Press “1” if it numeric
- Press “2” if it is a letter
- Message:
"The current year allowed amount for this procedure code is _________. "
NPI and PTAN Crosswalk Validation :
If you have made change to the NPPES system within the last 5-10 business days please note that those changes may not yet be reflected in our system.
Enter your NPI.
Enter your PTAN.
You will receive one of the following messages:
- Yes, your NPI and PTAN are currently on the crosswalk in our system.
- No, your NPI and PTAN are not currently linked in our system. Please visit the NPPES website, https://nppes.cms.hhs.gov and make sure that the NPI and PTAN are linked. If they are linked there, but are not cross walked in our system, please contact a Provider Customer Service Representative at NC 866.655.7996, TN 866.824.8572, ID 866.824.8593
Constant Prompts throughout the IVR:
- The following prompts are constant throughout the IVR:
- Press "7" to repeat information.
- Press "8" to return to the main menu.
- Press "9" for information on a different PTAN.
Example:
Checking status of a claim for a provider with a letter at the end to the PTAN.
PTAN 11111D, Medicare number 111111111A, date of service 010303
- Press "1" - claim status.
- Press "1" - PTAN ending with a letter.
- Press "11111# " - the numeric portion of the PTAN followed by #.
- Press "3", then "1" - if the letter is a D, press "2" for no second letter.
- Listen to PTAN repeated.
- Press "1" if the PTAN is correct.
- Press "1" for a Medicare number that ends in a letter or a letter-number combination.
- Press "111111111" - the numeric portion of the Medicare number.
- Press "1" - if the letter at the end of the Medicare number is an A.
- Listen to the Medicare number repeated and the first 3 digits of the patient's last name.
- Press "1" if the information is correct.
- Press "010303" - for the date of service.
