Customer Service Frequently Asked Questions
First Quarter 2005
- What information is required in order to obtain entitlement/eligibility data?
- How do I determine why my claim denied?
- Why doesn't a Customer Service Representative assist me when I call to inquire on the status of my claim?
- How do I determine if a service is covered?
- How do I determine if the patient has met their annual deductible?
- How do I determine how to bill a service or claim?
TopQ1. What information is required in order to obtain entitlement/eligibility data?
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This information is now available via the IVR. Providers must key the Name, Gender, Medicare Number and Date of Birth of the patient. Once this is verified, the provider follows the system prompts to obtain eligibility information to include the Part A and B entitlement dates, the yearly deductible status, and Medicare HMO information.
2. How do I determine why my claim denied?
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Denial information can be found on the Medicare Remittance Notice (MRN) Remark and Reason codes in the Glossary Section at the end of the MRN. Providers can also obtain this information via the IVR.
3. Why doesn't a Customer Service Representative assist me when I call to inquire on the status of my claim?
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CMS mandates that all Provider status requests must be obtained through the IVR. By utilizing this automated system, the Customer Service Representatives can be available to help you with questions that require personal assistance.
4. How do I determine if a service is covered?
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Through the use of Local Medical Review Policies (LMRP), National Coverage Determinations (NCD), Provider Bulletin articles and ListServ notices, coverage and filing guidelines can be obtained.
5. How do I determine if the patient has met their annual deductible?
- Following the Privacy Act of 1974 and CMS Privacy policies, providers must supply the patient's name, gender, Medicare number and Date of Birth in order to obtain if the patient has met their annual Deductible.
6. How do I determine how to bill a service or claim?
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Coding or billing guideline assistance can be found in the Local Medicare Review Policies, Medicare Bulletins, and Specialty Manuals at www.cignamedicare.com. Information can also be found via CMS Internet Only Manuals at www.cms.hhs.gov/manuals.
