The most recent JC Council meeting covered several key initiatives from CMS and CGS that could impact providers’ workflow, claim submissions, and communication processes. Here’s a breakdown of what you need to know.

CMS FHIR Project: Streamlining Data Exchange

CMS continues to advance the FHIR (Fast Healthcare Interoperability Resources) initiative, a system designed to improve the way healthcare data is shared across platforms. Using secure API connections, FHIR aims to:

Reduce manual data entry and paperwork
Improve the accuracy of patient and claim information
Speed up claims processing and reduce errors

For providers, this means a future where billing software, electronic health records (EHRs), and payer systems can communicate more seamlessly—saving time and minimizing administrative headaches.

Learn more about FHIR here: FHIR Index

TPE Updates and Communication Reminders

The council also reviewed quarterly results from Targeted Probe and Educate (TPE) audits. Being proactive and informed about TPE cases can help prevent delays and ensure claims are submitted accurately, reducing the likelihood of costly denials.

For providers with questions about TPE cases, there are designated inboxes for inquiries:

Remember: Do not include any PHI in email communications.

CGS Connect Program: Faster Pre-Dispensing Reviews

The CGS Connect Program provides a valuable opportunity for suppliers to request pre-dispensing reviews for certain codes, giving you a medical necessity assessment directly from a CGS reviewer. Key updates include:

Updated forms now include an “upgrade” option and a fax number field for faster responses.
The program now offers educational feedback that can improve documentation and decision-making for future referrals.

Providers are encouraged to leverage this program not only to meet compliance requirements but also to learn best practices for claim documentation.

Policy Updates: LCDs and NCDs

Several Local Coverage Determinations (LCDs) have completed their public comment period, including:

External Infusion Pumps (L33794)
Knee Orthoses (L33318)
Nebulizers (L33370)
Urological Supplies (L33803)

CMS will review comments and release final determinations soon.

Additionally, the RAD National Coverage Determination (NCD) went into effect on October 9, 2025, for claims with service dates on or after June 9, 2025. Providers should ensure their billing and documentation practices align with these updates to avoid claim issues.

MyCGS Updates: e-Letters and Electronic Signatures

MyCGS continues to evolve with versions 10.2, 10.3, and 10.4, introducing multiple enhancements. A major upcoming improvement is the e-Letters project, which will allow suppliers to receive TPE and redetermination letters electronically instead of via mail.

This feature is expected to:

Provide faster access to official correspondence
Streamline record management
Reduce paper dependency in day-to-day operations

The council also discussed electronic signature requirements. While CGS removed a previously posted educational document, the Provider Information Manual (PIM) still provides guidance on e-signature compliance.

Next Steps for Providers

Staying up to date with these developments can help your organization improve efficiency, maintain compliance, and reduce administrative burden. Here’s what to do now:

Familiarize yourself with FHIR and other digital initiatives to reduce manual work.
Use CGS Connect as an educational tool and to strengthen documentation.
Monitor LCD and NCD updates to ensure compliant billing practices.
Stay up to date with MyCGS releases, including MyCGS e-Letters, which will simplify communications and records management.

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