Tennessee / Idaho Customer Service Frequently Asked Questions
- 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 to I find out if Medicare is primary or secondary?
- How do I determine if the patient has met their annual deductible?
- How do I determine how to bill a service or claim?
- I have several CO-16/return reject denials. What is wrong with my claims?
- I have an offset on my remittance, what patient(s) is this for?
TopQ1. What information is required in order to obtain entitlement/eligibility data?
- 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?
- 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?
- 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. Customer Service Representatives will offer to automatically transfer you to the IVR system for your convenience.
4. How do I determine if a service is covered?
- 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 find out if Medicare is primary or secondary?
- The Privacy Act of 1974 and CMS Privacy policies require that providers supply the patients name, gender, Medicare number and date of birth to obtain Medicare Secondary Payer information. Customer Service Representatives can only release if Medicare is primary or secondary; they cannot release the name of the primary insurer.
6. 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.
7. How do I determine how to bill a service or claim?
- 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.
8. I have several CO-16/return reject denials. What is wrong with my claims?
- A return/reject (CO-16) denial is a claim that has missing or incomplete conditional/required data needed to process the claim. CO-16 denials carry no appeal rights. Further detail is provided in the remittance remark codes to describe what specific information is missing.
9. I have an offset on my remittance, what patient(s) is this for?
- Customer Service Representatives can assist you with determining the claim that created the receivable. The Finance Control Number (FCN) notated on your remittance is needed in order for Customer Service to provide this assistance. The Medicare number, patient name, date of service, and service code is also available on the initial letter sent by the Recovery department.
