On January 15, CGS notified providers of an issue related to the ordering/referring physician data in the DME MAC claim system. CMS provided a corrected file to the DME MACs in order to resolve the issue and that file has been loaded into CGS’ system. With the corrected file in place, claims are being processed with the current ordering/referring physician data from PECOS. Any claim that was previously denied incorrectly due to this issue will be reprocessed automatically.
The myCGS web portal and the Jurisdiction C IVR are also now accessing the corrected ordering/referring physician data file. You can use myCGS and/or the IVR to ensure that your ordering/referring physician NPI and name are valid prior to submitting your claim.