Reopen the previous request through IVR

Florida Medicare Telephone reopening requests via the IVR


Medicare Part B interactive voice response (IVR) allows providers/customers to request telephone reopenings on certain claims.

Features

• This enhancement is designed to make your requests easier and faster to process. Requests for telephone reopenings via the IVR will process the next day.

• Using this self-service feature will result in faster receipt of any applicable payments.

• The hours of availability are beyond the hours of availability for a customer service representative (CSR).

• IVR reopenings will be limited to simple, single-line requests.

• Bonus -- The number of telephone reopening requests via the IVR are unlimited within the allotted 30-minute time frame.

Types of reopenings available via the IVR

The following types of reopening requests are not available through a CSR; you must call the IVR for the following types of requests:

• Change date of service on paid claims (history corrections)

• Change diagnosis code

• Add, delete, change modifier (except modifiers listed below)

• Claims containing single detail lines (except requests to add modifier GV or GW to multiple-line claims for a beneficiary enrolled in hospice)

• Entitlement, Medicare Secondary Payer or Medicare Advantage Plan change in status

Types of reopenings that cannot be performed via the IVR

You may continue to speak with a CSR to request a telephone reopening for types of reopenings not available through the IVR.

• Previously adjusted claims

• Claims containing multiple detail lines (except hospice modifiers GV or GW or Entitlement reopenings)

• Pending claims

• Non-assigned claims

• Drug and drug administrations codes

• Request on claims containing the following modifiers, or requests to add or change these modifiers: 21, 22, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, SG, or WU.

Information you must have when calling the IVR for a reopening

• Provider’s National Provider Identifier (NPI), Tax Identification Number (TIN), and Provider Transaction Access Number (PTAN)

• Beneficiary’s last name and first Initial

• Beneficiary’s Medicare health insurance claim (HIC) number

• Beneficiary’s date of birth

• Caller’s name and 10-digit telephone number (3-digit area code and 7-digit number)

• Date of service

• Internal Control Number (ICN) -- can be obtained from your provider remit notice or the IVR when receiving a claim status

• Item(s) or service(s) at issue

• Reason for request

• New/revised information

IVR takes your request -- what’s next?

• IVR will confirm the request at the end of the call.

• If the request is approved, you will receive a letter and new remittance advice notice.

• If the request cannot be processed, a letter will be sent advising the provider of our decision.

• If the request would create an overpayment situation, the IVR will advise you to submit your request via a written redetermination form.

IVR hours of availability for telephone reopenings

• The IVR is available for requests for telephone reopenings from 7:00 a.m. to 6:30 p.m. Monday through Friday, and Saturday 7:00 a.m. to 3:00 p.m. ET.

• The toll-free Part B telephone number is 1-877-847-4992

Additional information

• No limit to the number of calls per day.

• Please have the information listed under “Information You Must Have When Calling the IVR for A Reopening” available when calling for an IVR reopening.

• If you are calling to perform an adjustment on multiples lines or on a claim with multiple issues, please call our customer service center at 1-866-454-9007 for providers in Florida and the U.S. Virgin Islands, and 1-877-715-1921 for providers in Puerto Rico.

• Additional IVR instructions are available via our IVR Part B operating guide.

To ensure you have all the information needed to submit your reopening request(s) via the IVR, we suggest using the IVR reopening request help sheet when preparing to call the IVR.

Understand Florida Medicare IVR operation

Additional IVR instructions are available via our IVR Florida Medicare Part B


Part B interactive voice response (IVR) operating guide 1-877-847-4992

First Coast Service Options Inc. (FCSO) strives to provide you with the most up-to-date automation features as possible. The IVR operating guide will help to increase your knowledge of the technology and services we offer our providers.

Hours of operation

IVR unit hours of availability

The IVR is available 24 hours a day, 7 days a week except for regularly scheduled maintenance. However, specific claim and/or eligibility information is available during the following times with the exception of holidays:

Monday-Friday 7:00 a.m. to 6:30 p.m., ET
Saturday 7:00 a.m. to 3:00 p.m., ET

Touchtone or speech

Providers in Florida have the option of selecting speech or touchtone when using the IVR. Touchtone is available to providers in the U.S. Virgin Islands and Puerto Rico. In order to receive the maximum results that you deserve when speaking, we offer the following tips:

• Use a telephone with a handset or headset

• Avoid using a speakerphone or cell phone

• Avoid calling from areas with loud background noise

• Speak the requested information clearly and in a quiet environment

*When using the speech recognition option on the IVR and keying the date is required (date of service, date of birth, etc.), the date must be given in an 8-digit format (mm/dd/yyyy).

In the event the system does not accept the spoken information, touch-tone is always available. In order to receive the maximum results that you deserve when using touch-tone, we offer the following tips:

• Dates should be entered in the following format (mm/dd/yy)

• To signal you are entering an alpha suffix or letter, press the * key

• Press the key that includes the letter, then the corresponding number that denotes where the letter is located on the number key.

• After all letters desired have been keyed, press the pound (#) sign to end your entry.

Use the numbers on the telephone keypad that corresponds to the patient or provider number:

A = *21#

Q =*72#

R = *73#

Z = *94#

Helpful tips

As a result of the Health Insurance Portability and Accountability Act (HIPAA), we are required to protect the privacy of all individuals. You must have the following information available for authentication to access patient eligibility, deductible and claims information via the IVR:

• National Provider Identifier (NPI)

• Tax Identification Number (TIN)

• Provider Transaction Access Number (PTAN)

• Beneficiary Medicare number

• Beneficiary name,

• Beneficiary date of birth

• Date of service (If applicable)

Main menu -- number/option

1. Closures. hot topics, outreach events, general questions and hours of operation

2. Status and reopenings

3. Eligibility

4. Pending claims

5. Check status

6. Remittance codes/pricing

7. Enrollment information

Closures and general information - press 1

• Training and holiday closures, press 1

• Hot topics, press 2

• Provider outreach and education information, press 3

• General appeals, website and information to have when calling Medicare, press 4

• Hours of operation, press 5

Claim and correspondence status and telephone reopenings - press 2

• For claim status, press 1

Assigned claim status

Pending, finalized, denied

Date of service

Amount submitted

Processed date

Deductible

Payment amount

Payment date

Check number

Internal Control Number (ICN)

Supplemental insurance (Forwarded or not)

Non - assigned claims

Processed date

Amount submitted

Payment date

• Additional claim detail

*This menu is offered after the information above has been voiced.

• Procedure code

• Date of service

• Billed amount and allowed amount for each procedure code

• Denial message

• For correspondence status, press 2

• IVR will voice date correspondence was completed and the Correspondence Control Number (CCN)

• To request a telephone reopening of a claim, press 3

This option provides callers with the ability to request a telephone reopening on a single detail line of a claim with the exception of hospice and entitlement related services.

Changes to date of service, press 1

To add, delete, or change a modifier, press 2

To change a diagnosis, press 3

Note: This option is only for the primary diagnosis for a procedure.

To have MSP, entitlement and Medicare Advantage claim denials reprocessed, press 4

Eligibility, Medicare Secondary Payer, Medicare Advantage, deductible and physical and occupational therapy information - press 3

• For current eligibility information, press 1

• Entitlement date

• Termination date (if applicable)

• Part B deductible

• Current Year deductible

• Previous Year deductible

• Medicare Advantage information

• Medicare is primary or secondary

If a Medicare Advantage plan is found, you can press 1 for more information.

• Medicare Advantage number

• Plan type

• Plan name

• Effective and termination date of policy

• Address of Medicare Advantage servicing provider

If Medicare is secondary, press 1 for MSP details

• Type of primary insurance

• Effective and termination date for all valid Insurers

• (Current or previous date of service)

• For eligibility for a previous date of service, press 2

• For physical and occupational therapy information, press 3

• For Medicare Advantage Plan information, press 4

• enters a specific Medicare Advantage plan number to receive specific information such as:

• Plan name

• Type of plan

• Address of plan provider

*Note - The Medicare Advantage plan number was formerly known as HMO Plan number.

Note: After primary eligibility information is obtained, the IVR will prompt the caller to press an option for additional eligibility.

Sub menu for additional eligibility menu

• Hospice

• Hospice effective date

• Termination date (if applicable)

• Servicing provider number

• Home health

• Home health effective date

• Termination date (if applicable)

• Servicing provider number

• Skilled nursing facility

• SNF effective date

• Termination date (if Applicable)

• Servicing provider number

Pending claims information and month-to-date or year-to-date dollar amount on file - press 4

• For pending claim information, press 1

• For month or year-to-date dollar amount, press 2

• For the previous year paid amount, press 3

Check information - press 5

• For the last three checks, press 1

• For check history by issue date, press 2

• For check history by check number, press 3

Definitions of remittance codes and pricing for procedure codes - press 6

• For remittance code information, press 1

• For pricing of a procedure code, press 2

Enrollment information - press 7

• For status of an enrollment application, press 1

• For a summary of applications and when to use them, press 2

• For a summary of documents required for certain specialties, press 3

• For mailing address and PECOS Internet enrollment information, press 4

• For open enrollment and participation in Medicare information, press 5

• For a summary of enrollment information available on our website, press 6

Repeat menu - press 8

This option returns callers to the main menu.

End call - press 9

This option ends the call in the IVR.

How to use touch tone on Medicare IVR

DME MAC A IVR User Guide - Using Touch-Tone Options

The IVR is programmed to allow for the entry of all data using touch-tone in the event the user is unable to
successfully speak to the IVR. These instructions detail how to use touch-tone to enter various types of
information requested by the IVR.

Note: Providers can switch between voice and touch-tone throughout the call (e.g., voice for Medicare number and touch-tone for beneficiary name); however, you cannot combine speech and touch-tone when providing a single element (e.g., voice for the numbers in a Medicare number and then touch-tone for suffix).


Using Touch-Tone for Alpha-Numeric Elements

When a single touch-tone entry contains alpha and numeric information (e.g., Medicare number) utilize the
following instructions.

Each button on the telephone keypad has a corresponding set of letters. Each letter is identified as a 1, 2, or 3 to indicate its position on that key.

Three keys are required to enter a letter.
Examples:
Medicare number 155-55-5555W
Press:
The first nine digits of the Medicare number:

* (star key) to indicate that you are about to enter a letter
The key containing the letter W
The position of the letter on that key (1st position)
Note: For the letters Q and Z, assume they appear on the 1 key as shown.



Common Letter Navigation
Letter     Touch-Tone Entry
A                     *21
B                     *22
C                     *23
D                     *31
M                    *61
T                     *81
W                   *91
S                     *73
Q                    *11
Z                     *12


Using Touch-Tone for Beneficiary Names

The format for entering the beneficiary’s name is LAST NAME, FIRST INITIAL. Select the number key
that represents the letter you wish to enter. For example, to enter the name John Doe, press 3-6-3-5 (entered
as DOEJ). To enter the letters Q or Z, use the 1 key.

Medicare ABN guide - How to complete

COMPLETING THE ABN

The revised ABN can be found at:

http://www.cms.gov/BNI/02_ABN.asp

The ABN is composed of five sections and 10 blanks, which must appear in the following order from top to bottom on the notice:

Notifier (A)

      Provider must place his name, address and telephone number at the top of the notice.

      If the billing and notifying entities are not the same, the name of more than one entity may be given in the notifier area.

Patient Name (B)

      Provider must enter first and last name of the beneficiary receiving the notice. The middle initial should also be used if there is one on the beneficiary’s Medicare card.

Identification Number (C)

      Medicare numbers or Social Security numbers must not appear on the notice.

Body (D)

      Providers must list the specific items or services believed to be non-covered in the blank of the note as well as in the first block of the table.

      In the case of partial denials, providers must list in the blank the excess component(s) of the item or service for which denial is expected.

Table (D, E, F)

      First Block (D).

                o Providers must list the specific items or services believed to be non-covered.

                 

      Reason Medicare May Not Pay (E).

                o Providers must explain in beneficiary-friendly language why they believe the items or services may not be covered by Medicare. Commonly used reasons for non-coverage are:

      “Medicare does not pay for this test for your condition.”

      “Medicare does not pay for this test as often as this (denied as to frequency).”

      “Medicare does not pay for experimental or research use tests.”

                 

Note: To be a valid ABN, there must be at least one reason applicable to each item or service listed. The same reason for non-coverage may be applied to multiple items.

                

Estimated Cost (F).

                o Provider must complete the Estimated Cost blank to ensure the beneficiary has all available information to make an informed decision about whether to obtain potentially non-covered services.

o Providers must make a good faith effort to insert a reasonable estimate for all the items or services listed. In general, we would expect the estimate be within $100 or 25 percent of the actual costs, whichever is greater. Examples of acceptable estimates would include, but not be limited to the following:

      For a service that costs $250:

                o “Between $150–$300.”

     o  “No more than $500.”

                

Multiple items or services that are routinely grouped can be bundled into a single-cost estimate.

Options 1, 2 or 3

The beneficiary or his representative must choose only one of the three options listed.

Option 1:

                o This allows the beneficiary to receive the item or services at issue and requires the provider to submit a claim to Medicare. This will result in a payment decision that can be appealed.

Option 2:

                o This option allows the beneficiary to receive the non-covered items or services and pay for them out-of-pocket. No claim will be filed and Medicare will not be billed. Therefore, there are no appeal rights associated with this option.

o Providers will not violate mandatory claims submission rules under 1848 of the Social Security Act when a claim is not submitted to Medicare at the beneficiary’s written request when selecting this option.

                 

Option 3:

                o This option means the beneficiary does not want the care in question. By checking this box, the beneficiary understands that no additional care will be provided and, thus, there are no appeal rights.

Additional Information (H)

Providers may use this space to provide additional clarification they believe will be of use to beneficiaries. For example:

                 

      A statement advising the beneficiary to notify his provider about certain tests that were ordered but not received.

      An additional dated witness signature.

      Other necessary annotations:

                o Annotations will be assumed to have been made on the same date as that appearing with the beneficiary’s signature.

Signature Box (I, J)

Once the beneficiary reviews and understands the information contained in the ABN, the Signature Box is to be completed by the beneficiary or representative.

                 

Signature:

                o The beneficiary or representative must sign the notice to indicate that he received the notice and understands its contents. If a representative signs, he should indicate “representative” after his signature.

                 

Date:

                o The beneficiary or representative must write the date he signed the ABN. If the beneficiary has physical difficultly writing and requests assistance in completing this blank, the date may be inserted by the provider. 

How to appeal on Medicare IVR

DME MAC A IVR User Guide - Appeals Options

Appeals - Option 4 

When the appeals option is selected, the IVR will request the following elements:

• National Provider Identifier (NPI)
• PTAN (10-digit supplier number)
• Last 5 digits of the Tax Identification Number (TIN)
• Beneficiary Medicare number
• Beneficiary first and last name (last name and first initial if using touch-tone)
• Beneficiary date of birth
• CCN

Once the authentication elements have been verified, the IVR will supply the following, if applicable:

• Document Control Number (DCN)
• All associated CCNs
• Appeal status
• Received date
• Dates of service
• Appeal decision


For appeals navigation options, please refer to the following:

                                      Appeals Navigation
Voice                                                  Touch-Tone Entry
Repeat That                                                    1
Next CCN                                                      2
Previous CCN                                                3
Change CCN                                                  4
Change Medicare Number                              5
Change PTAN                                                6
Main Menu                                                     7

CMN Status Options of Medicare IVR

DME MAC A IVR User Guide - CMN Status Options

CMN Status - Option 3

When CMN status is selected, the IVR will request the following elements:

• National Provider Identifier (NPI)
• PTAN (10-digit supplier number)
• Last 5 digits of the Tax Identification Number (TIN)
• Beneficiary Medicare number
• Beneficiary first and last name (last name and first initial if using touch-tone)
• Beneficiary date of birth
• HCPCS code

Once the authentication elements have been verified, the IVR will supply the following, if applicable:

• Initial certification date
• Recertification date
• Revised date
• Length of need

At any time during CMN status playback the caller can give the next Medicare number if multiple CMN
status requests are needed.

At the end of CMN status playback the caller has the option of saying; “change HCPCS” to obtain
information on another HCPCS code for the same beneficiary.

Medicare IVR - some Facts for Medicare secondary claims

IVR Fact

If the patient does not have an employer insurance plan that is primary to Medicare, the IVR will confirm this information. If the patient is covered under an employer insurance plan, the IVR will confirm the information and provide the effective date along with the employer insurance information. Medicare would be the secondary payer to the employer insurance plan.

However, the IVR statement “Medicare primary” does not negate the fact that the patient could have joined an MA plan that replaces traditional Medicare benefits. When the beneficiary has coverage through an MA plan, this plan is a temporary replacement of his traditional Medicare coverage. When this occurs, the patient will receive a new health insurance card from the MA plan and the traditional Medicare card will become inactive until that plan coverage is terminated.

This scenario can happen frequently and cause unnecessary claim denials because the provider’s office assumes without employer insurance and the IVR statement “Medicare Primary” that the claims should be filed to traditional Medicare. The provider should remain on the IVR and also obtain MA plan eligibility to have a complete picture of the patient’s health care coverage.

In addition to using the IVR, providers can also verify patient eligibility and claim status through an online inquiry process.

Medicare Secondary Payer (MSP)

Providers are required to file claims to Medicare using billing information obtained from the beneficiary to whom the item or service is furnished. Section 1862(b)(6) of the Social Security Act requires all entities seeking payment for any item or service furnished to complete, on the basis of information obtained from the individual to whom the item or service is furnished, the portion of the claim relating to the availability of other health insurance. Any provider who bills Medicare for services rendered to Medicare beneficiaries must determine whether Medicare is the primary payer for those services. Asking Medicare beneficiaries or their representatives questions concerning the beneficiary’s MSP status may accomplish this determination.

To conform to the law and regulations, the provider must verify MSP information prior to submitting a bill to Medicare. Verifying MSP information means confirming that the information furnished about the presence of another payer that may be primary to Medicare is correct, clear, and complete and that no changes have occurred.

The role of Medicare as the secondary payer is similar to the coordination of benefits clause in private health insurance policies. By federal law, Medicare is secondary payer to a variety of government and private insurance benefit plans. Medicare should be viewed as the secondary payer when a beneficiary can reasonably be expected to receive medical benefits through one or more of the following means:

 An Employer Group Health Plan (EGHP) for working aged beneficiaries.

 A Large Group Health Plan (LGHP) for disabled beneficiaries.

 Beneficiaries eligible for End Stage Renal Disease (ESRD).

 Auto/medical/no-fault/liability insurance.

 Veterans Affairs (VA).

  A Workers’ Compensation plan.

 The Federal Black Lung Program.

Any conditional primary payment(s) made by Medicare for services related to an injury is subject to recovery. A conditional payment is a payment made by Medicare for Medicare-covered services where another payer is responsible for payment and the claim is not expected to be paid promptly (i.e., within 120 days from receipt of the claim). Medicare makes conditional payments to prevent the beneficiary from using his own money to pay the claim. However, Medicare has the right to recover any payments. This includes payments that should have been paid under:

 Workers’ Compensation.

  Liability.

  Automobile, medical or no-fault insurance.

Questions that might be asked during patient screening include:

 Are you or your spouse currently working?

 Are you currently receiving any type of employer insurance benefits where you work now?

 Are you covered under group health care from a spouse, parent or guardian’s employer insurance plan?

· Are you receiving any type of medical care that could/should be covered under another insurance (e.g., workers’ compensation claim or liability accident)?

 Do you need treatment as a result of an accident/injury/illness where another person/party should be responsible?

Additional questions that could also be asked:

  Are you currently receiving benefits due to coal miner’s disease or through black lung benefits?

 Are you receiving benefits through the United Mine Workers Association?

 Is your injury/illness the result of a work-related accident?

 Are these services related to an auto/no-fault/liability accident?

 Are you a veteran and will this service be paid for by Veterans Affairs?

 Have you changed from “traditional” Medicare benefits to a Medicare Advantage replacement plan?

Each of these questions will help determine Medicare’s role as an insurance payer. Should Medicare process the claim as primary, as the secondary payer, or not at all due to another payer being responsible for the service(s)?

Supplemental Insurance Benefits

A patient may elect to purchase outside supplemental insurance or retain a secondary insurance plan through some type of retirement package from a previous employer. Both types of plans pay as a secondary or supplemental insurance plan to Medicare.

In some instances Medicare claims can be automatically transferred to the supplemental insurance plan either by an automatic crossover process or a process in place for those insurance plans designated as a Medigap plan. 

Supplemental insurance plans may offer an automatic crossover for those entitled to benefits, which is done through the Coordination of Benefits Contractor (COBC). The supplemental insurance eligibility is loaded into the patient’s national profile, and during claims processing the claim is automatically forwarded to the supplemental insurance for processing. This allows the provider office to file one claim and receive claim processing information from two insurance plans. 

Medigap plans are privately purchased and are designed to supplement Medicare coverage as well. Some Medigap insurance plans offer the same automatic crossover benefits as supplemental insurance plans. If the Medigap insurance does not provide automatic claim transfer, the provider must indicate on each Medicare claim the patient’s Medigap insurance information in order for the processed claim to be sent to the Medigap plan.

Medicare IVR submenu

DME MAC A IVR User Guide - Question Options

Questions - Option 8


When the questions option is selected, the IVR will present the caller with a submenu. Refer to the following for the submenu options.

Voice                                 Touch-Tone Entry                                 IVR Supplies
Phone Numbers                            1                         Commonly Requested Telephone Numbers
Addresses                                    2                          Commonly Requested Addresses
Hours of Operation                       3                          Customer Service and IVR Hours
CERT Information                         4                         Overview of the Medicare Comprehensive Error Rate
                                                                                Testing (CERT) Program

Redeterminations                           5                        Overview of the Medicare Redetermination Process
Repeat That                                   6
Main Menu                                    9

Using same or similar option on Medicare IVR

DME MAC A IVR User Guide - Same Options

Same or Similar - Option 7

The same or similar option only provides information on base codes, not related accessories or drugs. For
example, if a beneficiary has a manual wheelchair (K0001) and leg rests (K0195), the same or similar option
only provides equipment that is same or similar for the K0001. No information will be given on the K0195.
The Certificate of Medical Necessity option is still available which can give accessories and/or drugs related to a base code.

When same or similar status is selected, the IVR will request and collect the following elements:

• National Provider Identifier (NPI)
• PTAN (10-digit supplier number)
• Last 5 digits of the Tax Identification Number (TIN)
• Beneficiary Medicare number
• Beneficiary first and last name (last name and first initial if using touch-tone)
• Beneficiary date of birth
• HCPCS code

Once the authentication elements have been verified, the IVR will supply the following, if applicable:
• Initial certification date
• Recertification date
• Revised date
• Length of need
• Same or Similar HCPCS code
At any time during same or similar status the caller can give the next Medicare number if multiple same or
similar status requests are needed.The same or similar option only provides information on base codes, not related accessories or drugs. For
example, if a beneficiary has a manual wheelchair (K0001) and leg rests (K0195), the same or similar option
only provides equipment that is same or similar for the K0001. No information will be given on the K0195.
The Certificate of Medical Necessity option is still available which can give accessories and/or drugs related to
a base code.
When same or similar status is selected, the IVR will request and collect the following elements:
• National Provider Identifier (NPI)
• PTAN (10-digit supplier number)
• Last 5 digits of the Tax Identification Number (TIN)
• Beneficiary Medicare number
• Beneficiary first and last name (last name and first initial if using touch-tone)
• Beneficiary date of birth
• HCPCS code



Once the authentication elements have been verified, the IVR will supply the following, if applicable:

• Initial certification date
• Recertification date
• Revised date
• Length of need
• Same or Similar HCPCS code

At any time during same or similar status the caller can give the next Medicare number if multiple same or
similar status requests are needed.

At the end of same or similar status playback the caller has the option of saying; “change HCPCS” to obtain
information on another HCPCS code for the same beneficiary.

Providers must speak with a live customer service representative to obtain HCPCS codes beginning with the
letters A, L, or V. The IVR will not search for the same or similar items listed below:

• Diabetic Supplies
• External Breast Prosthesis
• Eye Prosthesis
• Facial Prosthesis
• Knee Orthosis
• Lower Limb Prosthesis
• Orthotic Footwear
• Refractive Lenses
• Spinal Orthosis TLSO and LSO
• Surgical Supplies
• Therapeutic Shoes for Diabetics
• Tracheotomy Supplies
• Urological Supplies
• TENS Supplies

Note: The same or similar option will provide information to the initial dates for HCPCS codes up to 5 years. The CMN option is still available which can give accessories and/or drugs related to a base code.

IVR Guide for information getting on offset - FCN number

DME MAC A IVR User Guide - Financial Options

Financial - Option 5 


When financial is selected, the IVR will request the following element:

• National Provider Identifier (NPI)
• PTAN (10-digit supplier number)
• Last 5 digits of the Tax Identification Number (TIN)

Once the authentication element has been verified, a submenu will ask if you want Information about:
Offsets (touch-tone 1), Voluntary Refunds (touch-tone 2), or Checks (touch-tone 3).

Note: For overpayments associated with 5 or more claims or Beneficiary Medicare Numbers, providers shall refer to their overpayment letter.

Information about Offsets
When information about offsets is selected, the IVR will request the following element:

• Financial Control Number (FCN)

The IVR will supply the following, if applicable:
• Nine digits of the Beneficiary Medicare number
• Date(s) of service
• Number of claims
• Offset amount
• Advises if offset has been satisfied

For offset navigation options, refer to the following:
                                               Offset Navigation
Voice                                                 Touch-Tone Entry
Repeat That                                                1
Change Offset                                             2
Voluntary Refund                                        3
Change PTAN                                            4


Voluntary RefundsWhen the voluntary refunds option is selected, the IVR will request the following element:
• Check number

The IVR will supply the following, if applicable:
• Check amount
• Check date
• Check status
• Check status date
• DCN check was applied to
• Date applied to DCN
• Amount applied to DCN

For voluntary refund navigation options, refer to the following:
                     Voluntary Refund Navigation
Voice                                     Touch-Tone EntryRepeat That                                    1
Change Check Number                   2
Change PTAN                                3


Checks

When the checks option is selected, the IVR will ask if you want Checks by Date (touch-tone 1) or Last
Three Checks (touch-tone 2).

When the “checks by date” option is selected, the IVR will request the following element:

• Check date

For both check options, the IVR will supply the following, if applicable:

• Total number of checks found
• Issue date
• Check date
• Check amount
• Check number
• Cashed date
• Check status (cashed/cancelled/voided/outstanding)
• Ability to order duplicate remittance

For checks navigation options, refer to the following:
                                           Checks Navigation
Voice                                                 Touch-Tone Entry
Repeat That                                                  1
Next Check                                                  2
Previous Check                                            3
Duplicate Remittance                                    4
Change Date                                                5
Change PTAN                                             6
Main Menu                                                  7

Getting pricing option on Medicare IVR

DME MAC A IVR User Guide - Pricing Options

Pricing - Option 6 


When pricing is selected, the IVR will request the following elements:

• National Provider Identifier (NPI)
• PTAN (10-digit supplier number)
• Last 5 digits of the Tax Identification Number (TIN)
• HCPCS code
• HCPCS modifier (if none, say “no modifier”)
• State

Once the authentication elements have been verified, the IVR will supply the following:

• Allowed amount from the provider fee schedule

For pricing navigation options, refer to the following:
                                             Pricing Navigation
Voice                                                Touch-Tone Entry
Repeat That                                                      1
Change HCPCS                                               2
Change Modifier                                               3
Change State                                                    4
Main Menu                                                       5

Medicare IVR - important points to follow

INTERACTIVE VOICE RESPONSE (IVR)

The IVR will provide eligibility and benefits information, claim and payment information, redetermination status, duplicate remittance advice and general information to the user.


The caller will need to have the following information when using the IVR:

* National Provider Identifier (NPI) number.

* Provider Transaction Access Number (PTAN).

* The last five digits of the Tax Identification Number (TIN).

*  Patient’s Medicare number.

*  Patient’s date of birth.

*  Patient’s last name.

*  Patient’s first name.

The IVR will give the following eligibility and benefits information:

*Part A and Part B effective and termination dates.

*Part B deductible for the current year.

*Part B deductible for prior years (Part B only).

*Physical and speech-language pathology cap information.

*Occupational therapy cap information.

*Managed care enrollment.

*Medicare Secondary Payer (MSP) information.

*Benefits under a different Medicare number.

*Hospice enrollment.

*Home health enrollment.

*Verification if the patient has received the pneumonia vaccine.

When using the IVR, providers must obtain complete patient eligibility to ensure claims are processed timely and accurately with unnecessary claim denials.



Key eligibility components that should be verified on the IVR are:

*Medicare effective and termination dates.

*Deductible information.

*MSP information.

*Coverage under a Medicare Advantage (MA) managed care plan.

Reminder: The IVR is a valuable resource for providers, but without complete patient information the IVR will not release patient eligibility information. It is important to obtain the patient’s complete name as it is listed on the Medicare card, the patient’s Medicare number, and their birth date. The IVR will not provide the needed information if the provider does not have valid patient information.

checking eligibility through Medicare IVR

DME MAC A IVR User Guide - Eligibility Options

Eligibility - Option 2

When the eligibility option is selected, the IVR will request the following elements:

• National Provider Identifier (NPI)
• PTAN (10-digit supplier number)
• Last 5 digits of the Tax Identification Number (TIN)
• Beneficiary Medicare number
• Beneficiary first and last name (last name and first initial if using touch-tone)
• Beneficiary date of birth
• Date of service

Once the authentication elements have been verified, the IVR will supply the following, if applicable:

• Part A and Part B effective/termination dates
• Current/prior year Part B deductible amounts
• Medicare Secondary Payer (MSP) type, insurer name, and effective/termination dates
• Medicare Advantage Plan number, name, address, telephone number and effective/termination dates
• Home health name, address, and effective/termination dates
• Hospice name, address, and effective/termination dates
• Date of death
• Corrected Medicare number

At any time during eligibility playback the caller can give the next Medicare number if multiple eligibility
requests are needed.

checking claims status through IVR

DME MAC A IVR User Guide - Claims Options

Claims - Option 1

When the claims option is selected, the IVR will request the following elements:

• National Provider Identifier (NPI)
• PTAN (10-digit supplier number)
• Last 5 digits of the Tax Identification Number (TIN)
• Beneficiary Medicare number
• Beneficiary first and last name (last name and first initial if using touch-tone)
• Date of service
Once the authentication elements have been verified, the IVR will supply the following, if applicable:
• Total number of claims located for the specified Medicare number/date of service
• Claim status
• Submitted amount
• Allowed amount
• Amount applied to deductible
• Payment amount
• Payment date
• Check number

For additional claim information, say Claim Details (touch-tone 4) to obtain the following, if applicable:

• Additional Documentation Request (ADR) dates
• Claim Control Number (CCN)
• Total number of line items
• Line Item information
o Date of service
o Submitted amount
o Allowed amount
o Procedure code
o Modifier
o ICD-9 Diagnosis
o Denial reason

• Ability to order duplicate remittance
If multiple claims are located, say Next Claim (touch-tone 2) to move to the next claim or say Previous
Claim (touch-tone 3) to move back to the previous claim. For additional claims navigation options, please
refer to the following:
 


                         Claims  Navigation
Voice                                                    Touch-Tone EntryRepeat That                                                               1
Next Claim                                                                2
Previous Claim                                                          3
Claim Details                                                             4
Duplicate Remittance                                                 5
Change Date                                                             6
Change Medicare Number                                        7
Change PTAN                                                          8
Main Menu                                                               9

Obtaining EOB or RA through IVR system

Ordering Remittance Advice (RA) Through the Claim Status Option of the Interactive
Voice Response (IVR) - Issue Identified

DME MAC Jurisdiction A has identified an error of not producing Remittance Advice
(RA) requests via the Claim Status method (Option 1) of the IVR. When requesting
 a copy of an RA via option 1 of the Claim Status menu, the system is sending a
Medicare Summary Notice (MSN) to the beneficiary instead of issuing an RA to the
 supplier. The Financial menu, option 5, may also be used to request an RA through
the IVR.

Until further notice, all suppliers should use the Financial menu, option 5, when
requesting a copy of the RA.

Eligibility verification throught Medicare IVR - Information required

Eligibility Options Available via the Jurisdiction A DME MAC IVR

The DME MAC A Call Center has seen an increase of calls due to eligibility denials
for a Medicare beneficiary.  Some of the common ANSI denials associated with eligibility
include, but aren't limited to:


* ANSI 22: Payment adjusted because this care may be covered by another payer per
coordination of benefits.
* ANSI 13: The date of death precedes the date of service.
* ANSI 24: Payment for charges adjusted.  Charges are covered under a capitation
 agreement/managed care plan.
* ANSI B15 with remark code N70: This service/procedure requires that a qualifying
service/procedure be received and covered.  The qualifying other service/procedure
has not been received/adjudicated.  Consolidated billing and payment applies.
* ANSI 45 with remark code N88: Charge exceeds fee schedule/maximum allowable or
 contracted/legislated fee arrangement.  This payment is being made conditionally.
 A Home Heath Agency episode of care notice has been filed for this patient.  When
a patient is treated under a HHA episode of care, consolidated billing requires
that certain therapy services and supplies, such as this, be included in the HHA's
payment. This payment will need to be recouped from you if we establish that the
 patient is concurrently receiving treatment under a HHA episode of care.
* ANSI B9: Patient is enrolled in a Hospice
* ANSI 109 with remark code M2: Claim not covered by this payer/contractor. You
must send the claim to the correct payer/contractor. Not paid separately when the
patient is an inpatient.
* ANSI 109 with remark code MA101: Claim not covered by this payer/contractor. You
must send the claim to the correct payer/contractor. A Skilled Nursing Facility
(SNF) is responsible for payment of outside providers who furnish these services/supplies
to residents.

Note:The ANSI denials listed above typically have a CO (contractual obligation)
or PR (patient responsibility) reported with the code.

The Centers for Medicare & Medicaid Services (CMS) requires suppliers to utilize
 self-service options, such as the interactive voice response (IVR) system.  When
calling the DME MAC A Call Center and asking for eligibility and/or explanation
of a denial, you will be directed back to the IVR.

The IVR, 866-419-9458, is available for the supplier community Monday -Friday, 6:00
a.m. - 7:00 p.m. EST and Saturday, 6:00 a.m. - 3:00 p.m. EST

In order to obtain eligibility through the IVR, suppliers will need to select option
2.  After selecting option 2, the IVR will request and collect the following elements:


* NPI
* PTAN (ten-digit supplier number)
* Last five digits of the Tax Identification Number (TIN)
* Beneficiary Medicare number
* Beneficiary first and last name (last name and first initial if using touch-tone)
* Beneficiary date of birth
* Date of service

Once the authentication elements have been verified, the IVR will supply the following
information:


* Part A and Part B effective/termination dates
* Current/prior year Part B deductible amounts
* Medicare secondary payer (MSP) type, insurer name, and effective/termination dates
* Medicare advantage plan number, name, address, telephone number, and effective/termination
dates
* Home health name, address, and effective/termination dates
* Hospice name, address, and effective/termination dates
* Date of death
* Corrected Medicare number

Effective January 14, 2011, a new enhancement was added to the Claims option (option
1) on the IVR.  Suppliers are able to select Claim Details (touch tone 4) in order
to obtain admission/discharge dates and patient status date if the claim denied
due to Home Health, Hospice, Inpatient Stay, or Skilled Nursing Facility.  Suppliers
will also be able to obtain the name and address of the facility.

Medicare IVR Main Menu user Guide

DME MAC A IVR User Guide - Main Menu Options

Main Menu Options

The main menu and subsequent menus can be navigated by using your voice or using touch-tone on the
telephone keypad. You can also use touch-tone entry for Provider Transaction Access Numbers (PTANs),
Medicare numbers, tax identification numbers (TINs), dates of service, dates of birth, HCPCS codes, and
beneficiary names. Touch-tone instructions and examples are also included in this guide.
Note: The 10-digit legacy supplier number is now being referred to as the PTAN.

Select the main menu option for a complete list of elements required from the caller and the information that
the caller will hear back from the IVR.

Voice                           Touch-Tone Entry
Claims                                        1
Eligibility                                     2
CMN Status                              3
Appeals                                     4
Financial                                    5
Pricing                                       6
Same or Similar                         7
Questions                                   8
Description of Main Menu Options *

how to check claim status, eligibility, HMO and deductible through Medicare IVR

IVR Quick Reference Guide

MAIN MENU

�� For information about current Medicare changes, issues, and Hot Topics, press 1
�� To receive Claim and Correspondence Status or request a Telephone Reopening, press 2
�� For Eligibility, HMO, Deductible and physical and occupational limitation information, press 3
�� For pending and payment floor claims or to receive month – year dollar amounts currently on file, press 4
�� To receive check information, press 5
�� Remittance Code Definitions and Pricing definitions, press 6
�� For Enrollment information, press 7

CHECK HISTORY BY CHECK NUMBER

�� From the main menu, press 5, then press 3

CHECK HISTORY BY ISSUE DATE

�� From the main menu, press 5, then press 2


CLAIM STATUS

�� From the main menu, press 2, then press 1

CORRESPONDENCE STATUS

�� From the main menu, press 2, then press 2
�� Receive info on another claim, press 2
�� To receive info on a different control number, press 3
�� To receive info on a different provider number, press 6


ELIGIBILITY, HMO, DEDUCTIBLE AND PHYSICAL AND OCCUPATIONAL LIMITATION INFORMATION

�� From the main menu, press 3
�� For Current Eligibility and Deductible, press 1
�� For Eligibility on Previous Dates of Service press 2
�� For Physical and Occupational Therapy Information press 3
�� For Medicare Advantage Plan (formally HMO) information, press 4

ENROLLMENT STATUS

�� From main menu, press 7

LAST 3 CHECKS

�� From the main menu, press 5, then press 1

Appeal the cliam and changing information through medicare IVR & hot topics

IVR Quick Reference Guide

MEDICARE ADVANTAGE NAME AND ADDRESS

* From the main menu, press 3 then press 4



MEDICARE HOT TOPICS

* From the main menu, press 1
* For info on the Paperless Claim Initiative, press 1
* For PCS hours of operation, press 2
* For Medicare paper claim submission and Web site info, press 3
* To learn about IVR features, press 4
* For General Appeals information, press 5
* For Upcoming Seminar information, press 6
* To repeat this menu, press 7
* To return to the main menu press 8

MONTH OR YEAR TO DATE DOLLAR AMOUNT

�� From the main menu, press 4, then press 2
�� To receive information on different provider number, press 1

PENDING CLAIMS

�� From the main menu, press 4, then press 1
�� To receive information on different provider number, press 1

PRICING INFORMATION

�� From the main menu, press 6, then press 2


REMITTANCE CODE DEFINITIONS

* From the main menu, press 6, then press 1

TELEPHONE REOPENING OF A CLAIM

* From the main menu, press 2, then press 3
* For changes to the date of service, press 1
* To add, delete, or change a modifier, press 2
* To change a diagnosis, press 3
* To have MSP, Entitlement and Medicare Advantage Plan claim denials reprocessed, press 4

tips to use Medicare IVR - How to enter alphabet - what are info required to validate

Medicare Provider Part B HELPFUL TIPS WHEN USING THE IVR:

* Use a telephone with a handset or headset
*  Avoid using a speakerphone or cell phone
*  Avoid calling from areas with loud background noise.
*  Speak the requested information clearly


AREAS WHERE VALIDATION IS REQUIRED:

* Status Items – National Provider Identifier (NPI), Provider Transaction Access Number (PTAN), Tax Identification Number (TIN), Patient Medicare Number & Name as shown on the Medicare Card, Date of Service.

* Eligibility Items –NPI, TIN, and PTAN, Patient Medicare Number and Name as shown on the Medicare Card, Date of Birth

* Pending Provider Claims – NPI, TIN, and PTAN

* Provider Check Information – NPI, TIN, and PTAN

To enter the alphabetical portion of any name or number, you must indicate you are entering an alphabetical character, by pressing the * key. Second, press the key containing the letter you wish to enter. Third, press the number 1,2 or 3 depending on the position of the number of that key. (#) should be used at the very end.

For Example:
To enter A, press *, 2, 1#
To enter B, press *, 2, 2#

Voice dates as March 31st, 2008. When keying required, enter the two-digit month, two-digit day, and the 4-digit year (Both 2 and 4 digit year accepted when using touchtone only.)

(END HELPFUL TIPS)