Claims Processing
This section has important information about filing claims to the DME MAC. Most Medicare suppliers are required to bill claims electronically (rather than paper) in accordance with the Administrative Simplification Compliance Act (ASCA).
- Claims Submission
- How to submit a DME claim to CGS.
- Medicare Secondary Payer (MSP)
- Is another insurance involved with your claim?
- Modifier Finder Tool
- Are you a Medicare supplier who routinely uses modifiers in billing your claims to Medicare?
- Online Claim Status Inquiry & Beneficiary Eligibility
- Claim Status Inquiry (CSI) is a dynamic tool that allows the supplier community to electronically check the status of production claims after they have passed the front-end edits. Beneficiary Eligibility (BE) allows you to electronically obtain eligibility information on Medicare beneficiaries prior to claim submission.
- Comprehensive Error Rate Testing
- The Centers for Medicare & Medicaid Services (CMS) developed the Comprehensive Error Rate Testing (CERT) program to produce national, contractor-specific, and service-specific paid claim error rates. Find CERT information and resources here.
- Appeals
- Was your claim denied?
- Reopenings
- How to correct a claim when you made a simple mistake.
- Overpayment Recovery
- Medicare payments received in excess of amounts due and payable under the statute and regulations
