Claims Submission
- Supplier Enrollment
- Claim Submission
- Having a Problem Coding a Claim?
- Timely Submission of Claims
- What To Do When a Claim Denies
- Electronic Data Interchange (EDI)
- Administrative Simplification Compliance Act (ASCA)
- Comprehensive Error Rate Testing (CERT)
- National Provider Identifier (NPI)
- Claims Forms
CIGNA Government Services is committed to providing the supplier community with the appropriate resources for accurately and efficiently billing Durable Medical Equipment (DME) to the Medicare program. You are encouraged to review the information below to assist with the submission of DME Claims. You are also encouraged to return to this site periodically for updated information.
Supplier Enrollment
To bill DME claims to Medicare, you must enroll as a supplier in the Medicare program. To enroll as a supplier of DME, please contact the National Supplier Clearinghouse (NSC). The NSC is responsible for enrolling DME suppliers in the Medicare program.
Claim Submission
The following links provide educational opportunities and resources that will assist you in accurately and efficiently submitting claims to CGS.
- How To Fill Out a Claim Form -- This online educational course provides the basics for submitting a claim.
- Supplier Manual -- The Supplier Manual provides additional and more detailed guidance regarding claims submission and other claim related activities, such as appealing claim denials, coverage, etc
- Coverage and Pricing -- The Coverage and Pricing section provides detailed information on what we pay for and when, and how much we pay. Information includes our Local Coverage Determination (LCDs) policies, fee schedules, and information on our Medical Review department.
- Additional Education -- The Education section provides you with numerous opportunities to increase your knowledge of the Medicare program. CGS offers online courses, live Workshops, interactive Webinars, as well as other opportunities. This section is updated frequently, so visit often.
TopHaving a Problem Coding a Claim?
The PDAC (Pricing, Data Analysis and Coding Contractor) provides applications to assist with the coding of claims. The DMECS application provides HCPCS coding assistance and national pricing information via searches for HCPCS Level II codes and modifiers, DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies), and(CMS)national fee schedules. DMECS is designed to assist the public with the coding of DMEPOS for submission to the DME MACs.
Timely Submission of Claims
Medicare claims must be submitted within the following time limits:
| For services provided between: | The claim must be submitted by: |
|---|---|
| October 1, 2006 and September 30, 2007 | December 31, 2008 |
| October 1, 2007 and September 30, 2008 | December 31, 2009 |
What To Do When a Claim Denies
Ever wonder what to do when a claim denies? CIGNA Government Services suspects that you are not alone if you answered "yes". As a result, CIGNA Government Services has created the following guide to help you determine what your next steps should be when a claim denies. For example, did you know that you can resubmit a claim that denies CO173 or CO176? Frequently a CO173 and CO176 denials are the result of a missing CMN. Instead of sending to Reopenings or Redeterminations, you can just resubmit the claim with the CMN information. By resubmitting the claim, you are utilizing the fastest processing option. You are encouraged to utilize the following guide the next time a claim denies. The guide does not cover all scenarios, but rather the most common. CIGNA Government Services will be adding additional information to this guide from time to time. As a result, we encourage you to visit this site to ensure that you are utilizing the most current information.
Electronic Data Interchange (EDI)
The submission of claims in an electronic format is a requirement for the vast majority of DME suppliers. Enrolling in the EDI (Electronic Data Interchange) program should be a first step for most DME suppliers. Enrollment into EDI for DME suppliers is handled by the CEDI (Common Electronic Data Interchange).
Submitting claims electronically provides several benefits:
- Faster payment. Electronic claims are paid earlier than paper claims.
- Earlier detection of claim errors. Claims submitted electronically immediately go through a series of editing, reducing the likelihood of claims being denied for payment.
- Availability of free software. A free billing software has been developed based on the requirements of the HIPAA-standard format. This software offers valuable features to assist with electronic claim submission, archiving and reporting.
- Lower administrative costs. Claims submitted electronically reduce postage and other paper-related expenses while increasing efficiency.
- Access to other transactions. In addition to billing claims electronically, suppliers are also able to take advantage of other electronic transactions such as; 835 - Electronic Remittance Advice (ERA).
If you are interested in checking Claims Status Inquiry or Beneficiary Eligibility through an online process, please visit our Claims Status Inquiry or Beneficiary Eligibility page.
Administrative Simplification Compliance Act (ASCA)
ASCA mandates the submission of electronic claims to Medicare unless the supplier meets certain exceptions described within the law.
If an exception is met Medicare paper claims must be submitted on the Health Insurance Claim Form {CMS-1500 (08-05)} and no superbills can be accepted.
Refer to the MLN Matters article MM3440: Administrative
Simplification Compliance Act (ASCA) Enforcement of Mandatory Electronic
Submission of Medicare Claims 
for
additional information.
Comprehensive Error Rate Testing (CERT)
Helpful links, CERT sample letters, and detailed CERT information can be found at our CERT resource page.
National Provider Identifier (NPI)
NPI Reminders:
Claims received on or after May 23, 2008 must contain an NPI only for primary and secondary providers. Claims will be rejected if an NPI is not submitted.
Legacy IDs are no longer permitted on the(CMS)1500 claim form. Claims will be rejected if Legacy IDs are submitted.
EMC claims must not contain the 1C or 1G value in the REF01 element. Claims will be rejected if 1C or 1G value is submitted.
Why are claims returned:
- Invalid supplier number/National Provider Identifier (NPI)
- Invalid Health Insurance Claim Number (HICN)
- No Healthcare Common Procedure Coding System (HCPCS code) submitted on claim form
- Health Insurance Claim Form (CMS-1500 (08-05)) submitted without a back
- No date of service submitted on (CMS-1500 (08-05)) claim form
Forms
Claims forms, including the ADMC Request form and the Suggested Intake Form can be found on our Forms home page.
