Payer Updates & Resources

Payer Updates

October 29, 2018

Illinois MGMA is represented with the Jurisdiction 6 Contractor Advisory Committee through NGS Medicare. A Committee meeting was held recently which included the following highlights:

  • On September 17, 2018, CMS changed front end edits of claims for nurse practitioners and physician assistants when more than one E/M service is billed on the same date. It is expected that the specialty of the supervising MD be appended to box 19 on all claims in the following format: “SPEC 06” , “SPEC 26” as examples. More details can be found here: E&M NGS
  • NGS will be initiating a new listserv called “RuralServ” to provide education and information to providers in rural areas. Be on the lookout for more details about this communication in the near future
  • CMS is requiring that any existing providers that want to change their specialty to Undersea and Hyperbaric Medicine must do so by submitting a change of information application via enrollment
  • CMS wants to remind practices that any beneficiary that has dual eligibility in both Medicare and Medicaid cannot be balance billed for services. This includes practices that are not participating in one or the other of Medicare or Medicaid
  • CMS is resuming provider revalidation on a 5 year schedule. NGS reminds all that revalidation can be done online via PECOS
  • CMS has developed a terrific preventive services chart that includes the current coding possibilities for the Influenza Vaccine. You can access the chart here: PREVENT CHART
  • For the new member Medicare cards, please note that remittance advices will return the member’s new ID even when the old SSN is submitted on the claim. While the old SSN is still valid until the end of 2019, CMS recommends that you begin the transition process of using the new MBI whenever possible



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