Resources

  • R.2.1- Eligibility Request Form
  • R.2.2- Intake Document
  • R.2.3- Delivery Ticket (HME)
  • R.2.4- Beneficiary Authorization
  • R.2.5- Monthly Beneficiary Authorization for Non-Assigned Rentals
  • R.2.6- Advanced Beneficiary Notice
  • R.2.7- Immunization Administration
  • R.3.1- PCN List updated 08/07/2022
  • R.3.2- EBS Payer Sheet Effective 06/27/2023 (adds 99 for indicating a secondary insurance)
  • R.3.3- NCPDP Instructions for Billing Vaccines (08/23)
  • R.3.4- NCPDP Instructions for Billing the Additional "At Home" Code for Remote Vaccine Administration (Now includes flu, pneumonia, COVID, and Hep B)
  • R.3.5- NCPDP Instructions for Billing Diabetic Supplies (07/23)
  • R.3.6- NCPDP Instructions for Billing Continuous Glucose Monitoring CGM's (09/23)
  • R.3.7- NCPDP Instructions for Billing Diabetic Footwear (08/23)
  • R.3.8- NCPDP Instructions for Nebulizers and Accessories (07/23)
  • R.3.9- NCPDP Instructions for Respiratory Medications (07/23)
  • R.3.10- NCPDP Instructions for Point of Care Testing (07/23)
  • R.3.11- NCPDP Instructions for Billing Diabetes Self Management Training/Education
  • R.5.1- Medicare Jurisdiction Map
  • R.5.2- Medicare Enrollment Contractors
  • R.5.3- All Medicare Contractors by State
  • R.5.4- Interactive Contractor Map
  • R.5.5- CMS Regional Offices
  • R.5.6- PECOS DME/POS Provider Enrollment/Registration
  • R.5.7- Medicare Revalidation List (Check to see if your PTAN is due for revalidation.)
  • R.5.8- NPPES-NPI Directory/Enrollment
  • R.5.9- CMS-855S DME/POS Medicare Enrollment
  • R.5.10- CMS-855I Immunization for a Sole Proprietor Enrollment Application
  • R.5.11- CMS-855B Immunization/DSMT for a Corporation Enrollment Application
  • R.5.12- Medicare Enrollment Speciality Codes
  • R.5.13- State Licensure Database
  • R.5.14- Pay CMS Application Fee for New Enrollments or Revalidations
  • R.5.15- Immunization Participating Provider Agreement Form
  • R.5.16- CMS-588 Medicare Electronic Funds Transfer Agreement
  • R.5.17- W-9 Tax Number Certification for Private Insurance
  • R.5.18- DME POS Site Inspection Form
  • R.5.19- DME POS Site Inspection Form
  • R.5.20- Request a Duplicate Medicare Welcome Letter
  • R.5.21- Medicare Supplier Database
  • R.5.22- Supplier Standards (English)
  • R.5.23- Surety Bond Companies Approved by Medicare
  • R.5.24- Surety Bond Exemptions
  • R.5.25- Employee The Right People-Search OIG Exclusions Database
  • R.5.26- Ultimate Guide to Understanding Medicare
  • R.5.27- CMS Revalidation Due Date List (from this link click on View Data to search)
  • R.5.28- CMS Fast Facts on Beneficiary Population
  • R.5.29- VA Claims Processing
  • R.5.30- NP East DME Enrollment Contractor - Novitas Solutions
  • R.5.31- NP West DME Enrollment Contractor - Palmetto GBA
  • R.5.32- Breakdown of Medicare and Medicare Advantage by State
  • R.5.33- Instructions for Submitting Fingerprints to Accurate Biometrics for CMS855S Applications
  • R.6.1- CLIA Waiver Application
  • R.6.2- CLIA State Agency Contacts
  • R.6.3- CMS CLIA Informational Site
  • R.6.4- CDC Self-Assessment Checklist for Good Testing Practices
  • R.6.5- CDC Train - CEU Course for Laboratory Training
  • R.6.6- FDA CLIA Waiver Tests
  • R.6.7- MM11916 07/24/2020 New Waived Tests
  • R.6.8- FDA EUA for COVID-19 Testing Complexity
  • R.6.9- CLIA Laboratory Look Up Tool
  • R.6.10- COVID Testing Fee Schedule
  • R.6.11- Abbott Test Coding and Allowables
  • R.6.12- BD Test Coding and Allowables
  • R.6.13- Cepheid Test Coding and Allowables
  • R.6.14- At Home COVID 10 Test Kits : CMS FAQs
  • R.6.15- Horizon New Jersey Response to Processing COVID Treatment and Testing Claims
  • R.6.16- Aetna response to Processing COVID Treatment and Testing Claims
  • R.6.17- UHC Response to Processing COVID Treatment and Testing Claims
  • R.6.18- OTC COVID Test Guidance from CMS
  • R.6.19- Can I Charge a Collection Fee? Your question is answered here....see page 4-5
  • R.7.1- Get the Facts: CMS Video Regarding WHO can Provide TeleHealth Visits
  • R.7.2- ASHP Explains Pharmacist Services that ARE and Are NOT Allowed to be Billed to Medicare
  • R.7.3- NCPDP: Billing Guidance for Pharmacists' Professional and Patient Care Services
  • R.7.4- NCPA: CMS Rules Regarding Pharmacists Ability to Provide COVID-10 Testing
  • R.8.1- Immunization Information Systems (IIS)
  • R.8.2- HRSA for Uninsured Patients
  • R.8.3- HRSA for Unpaid Insurance Vaccine Claims, Deductibles, and Coinsurance
  • R.8.4- Optum Pay
  • R.8.5- CMS Informational Web Page
  • R.8.6- COVD Vaccine and Monoclonal Antibodies Allowables
  • R.8.7- EBS CSV Claims Upload Template
  • R.8.8- COVID At Home Guidelines for Payment
  • R.9.1- Money Pox Vaccine and Lab Coding
  • R.9.2- Monkey Pox Vaccine Administraton National Payment Amount (Regionally Adjusted)
  • R.10.1- Search for DSMT Accredited Facilities
  • R.10.2- How to Get Your DSMT Program Accredited Through AADE
  • R.10.3- DSMT Information on Getting Started
  • R.10.4- DSME Health Insurance coverage required - lawatlas
  • R.10.5- State Profiles: Diabetes Self-Management Education and Training Fact sheets on diabetes and DSME/T coverage
  • R.11.1- Tool to Determine Payer Coverage of Continuous Glucose Monitoring Services
  • R.11.2- FDA Product Classification Device Listing
  • R.11.3- Continuous Glucose Monitor (CGM) Supply Allowance Date of Service Calculator
  • R.12.1- Primary Care First Model - NP's to Order and Certify Diabetic Footwear in 26 States through December 31, 2025
  • R.12.2- Primary Care First Model - Enrolled Practices
  • R.13.1- Health and Wellness by city
  • R.14.1- DME Services
  • R.14.2- PAP & RAD Services
  • R.14.3- Oxygen Services
  • R.14.4- Invasive Ventilator Services
  • R.14.5- Non Invasive Ventilator Services
  • R.15.1- CAQH Professional Enrollment
  • R.15.2- Find Medicare Advantage Plans in specific areas
  • R.15.3- Ambetter, Sunshine Health
  • R.15.4- Allwell Medicare Advantage
  • R.15.5- Cigna Health Spring
  • R.15.6- Cigna
  • R.15.7- Humana
  • R.15.8- UHC Community Plan
  • R.15.9- United Healthcare for Individuals (Pharmacies and Medical Supply Stores call 1-877-842-3210..enter tax id then Credentialing, Medical, Join the Network)
  • R.15.10- United Healthcare Network Contract Managers
  • R.15.11- UHC Letter of Interest to Join a Closed Network Form
  • R.15.12- UHC Network Management Contacts (All States)
  • R.15.13- Aetna (Coventry and Meritain is also owned by Aetna)
  • R.15.14- Alliant Health Plans
  • R.15.15- Blue Cross and Blue Shield Federal Employee Program (Find your state enrollment contact)
  • R.15.16- BCBS of Arkansas Provider Enrollment Through Availity
  • R.15.17- Blue Cross Blue Shield of Illinois
  • R.15.18- Blue Cross Blue Shield of Kansas
  • R.15.19- Anthem and Blue Cross Blue Shield (Choose Other and then choose Ancillary Providers from the next screen) (CA, CO, CT, GA, IN, KY, MA, MO, NV, NH, NY, OH, VA, WI)
  • R.15.20- Kentucky Anthem BCBS Provider Enrollment Form/Instructions (KY Pharmacy)
  • R.15.21- BCBS of Florida- Florida Blue (Step by Step Instructions to register through Availity)
  • R.15.22- Blue Cross Massachusetts (DME providers enroll as institutional)
  • R.15.23- Blue Cross Blue Shield of Texas
  • R.15.24- CareFirst Blue Cross Blue Shield
  • R.15.25- Care Source (OH, KY, GA, IN, WV)
  • R.15.26- EmblemHealth
  • R.15.27- Essence Healthcare Medicare HMO (Missouri)
  • R.15.28- Florida Blue Contract Request Form
  • R.15.29- Wellcare Provider Enrollment
  • R.15.30- Arkansas PASSE - Summitt Community Care
  • R.15.31- Arkansas PASSE - Empower
  • R.15.32- Arkansas PASSE - Arkansas Total Care
  • R.15.33- Healthy Blue LA Provider Application Request
  • R.15.34- Healthy Blue LA Network Development Team Contacts
  • R.15.35- Tricare West Region
  • R.15.36- Tricare East Region/Humana Military
  • R.15.37- Wellmark BCBS of Iowa
  • R.15.38- Missouri Medicaid Home State Health Contract Request Form
  • R.15.39- MissouriCare/WellCare
  • R.15.40- Aetna NJ
  • R.15.41- Amerigroup New Jersey
  • R.15.42- Horizon NJ
  • R.15.43- United Healthcare NJ
  • R.15.44- WellCare NJ
  • R.15.45- PA MetroPlus Health Plan
  • R.15.46- PA Affinity Health Plan
  • R.15.47- PA GHI/HIP/Emblem Health
  • R.15.48- PA Fidelis Care
  • R.15.49- Independent Health
  • R.16.1- Senate Listings
  • R.16.2- House Representative Listings
  • R.16.3- American Association for Homecare
  • R.16.4- CMS Employee Contact Information
  • R.16.5- Current Legislative Activities
  • R.17.1- Insurance Commissioner Contacts
  • R.18.1- HCPCS to Accreditation Code Crosswalk
  • R.18.2- Pharmacy Exemption Attestation Letter NP West Region
  • R.18.3- Pharmacy Exemption Attestation Letter NP East Region
  • R.18.4- DME/POS Information for Pharmacies (Seeking Exemption from Accreditation)
  • R.18.5- DME Accreditation Organizations approved by CMS
  • R.18.6- ACHC - Accreditation Organization for DME/POS Suppliers
  • R.18.7- DME/POS Quality Standards
  • R.18.8- The Basics of DME/POS Accreditation
  • R.19.1- Competitive Bidding Education
  • R.19.2- VGM Video: CMS Proposed Changes Issued July 11, 2018
  • R.19.3- Search for a Competitive Bid Area by Zip Code
  • R.19.4- DMEPOS Competitive Bid Geographic Classifications (by VGM) Find the boarders of each CBA
  • R.19.5- Find a Contract Supplier
  • R.19.6- Grandfathering Information
  • R.19.7- Subcontracting of DMEPOS Services
  • R.19.8- Licensure for Bidding Suppliers
  • R.19.9- Traveling Beneficaries
  • R.20.1- Round 1 Rebid Contract Suppliers
  • R.20.2- Round 1 Payment Amounts - All Products
  • R.20.3- Round 2 Competitive Bidding Area Zip Codes (pdf)
  • R.20.4- Round 2 Competitive Bidding Area Zip Codes (Excel)
  • R.20.5- Round 2 and NMO Contract Supplier List
  • R.20.6- Round 2 Single Payment Amounts
  • R.20.7- National Mail Order Diabetic Supply Single Payment Amounts
  • R.20.8- Round 1 Recompete Contract List
  • R.22.1- Noridian Healthcare Solutions Jurisdiction A
  • R.22.2- Cigna Government Services Jurisdiction B
  • R.22.3- Cigna Government Services Jurisdiction C
  • R.22.4- Noridian Healthcare Solutions Jurisdiction D
  • R.23.1- DMEPOS HCPCS Code Jurisdiction List - What services are covered under what division of Medicare
  • R.23.2- Noridian Jurs A DME on Demand
  • R.23.3- Noridian Jurs A Forms
  • R.23.4- Cigna Jurs B myCGS Web Portal
  • R.23.5- Cigna Jurs B Online Education Center
  • R.23.6- Cigna Jurs B Online Tools
  • R.23.7- Cigna Jurs C myCGS Web Portal
  • R.23.8- Cigna Jurs C Online Education Center
  • R.23.9- Cigna Jurs C Online Tools
  • R.23.10- KE/KY Modifier Tool
  • R.23.11- Noridian Jurs D Medicare Portal
  • R.23.12- Noridian Jurs D Denial Tools
  • R.23.13- Noridian Jurs D Forms
  • R.23.14- Noridian Jurs D Calculators and Tools
  • R.23.15- Noridian Check Rural Zip Code
  • R.23.16- Noridian Jurs D DME on Demand
  • R.24.1- CGS Link to Local Coverage Determinations/Policy Articles
  • R.24.2- Noridian Link to Local Coverage Determinations/Policy Articles
  • R.24.3- Telehealth
  • R.24.4- DSMT and MNT Services
  • R.24.5- List of Items that Require Face to Face Encounter and Written Order Prior to Delivery (updated as of 04/13/2023)
  • R.25.1- Jurisdiction A Prior Authorization Form
  • R.25.2- Jurisdiction B Prior Authorization Form
  • R.25.3- Jurisdiction C Prior Authorization Form
  • R.25.4- Jurisdiction D Prior Authorization Form
  • R.25.5- Power Mobility Devices (PMDs): Complying with Documentation & Coverage Requirements
  • R.25.6- Local Coverage Determination for PMDs
    • R.25.6.1- Prior Authorization Lookup Tool
  • R.26.1- Diagnosis Coding
  • R.26.2- ICD 10 Look Up Tool
  • R.26.3- ICD 10 Index
  • R.26.4- ICD 10 Index
  • R.26.5- ICD 10 Neoplasm Index
  • R.26.6- ICD 10 External Causes Index
  • R.26.7- ICD 10 Drug and Chemical Index
  • R.27.1- Continuation Form
  • R.27.2- Enteral and Parenteral Nutrition
  • R.27.3- External Infusion Pumps
  • R.27.4- Osteogenesis Stimulators
  • R.27.5- Oxygen
  • R.27.6- Seat Lift Mechanisms
  • R.27.7- TENS Transcutaneous Electrical Nerve Stimulator
  • R.27.8- Group 1 Support Surfaces
  • R.27.9- Group 2 Support Surfaces
  • R.29.1- Documentation Checklists as published by Noridian (Jurs A)
  • R.29.2- Documentation Checklists as published by CGS (Jurs B)
  • R.29.3- Documentation Checklists as published by CGS (Jurs C)
  • R.29.4- Documentation Checklists as published by Noridian (Jurs D)
  • R.30.1- Outreach and Education The Medicare Learning Network
  • R.30.2- CMS link to MLN Matters Education Articles searchable list
  • R.30.3- Purchase Option Letter
  • R.33.1- What Products Are Payable Under Consolidated Billing Guidelines
  • R.33.2- Place of Service Codes
  • R.34.1- ABN English CMS-R-131 (03/2020) PDF Format
  • R.34.2- ABN English CMS-R-131 (03/2020) FOR NON ASSIGNED CLAIMS ONLY PDF Format
  • R.34.3- ABN English CMS-R-131 (03/2020) Word Format
  • R.34.4- ABN English CMS-R-131 (03/2020) FOR NON ASSIGNED CLAIMS ONLY Word Format
  • R.34.5- ABN Spanish CMS-R-131 (03/2020) PDF Format
  • R.34.6- ABN Spanish CMS-R-131 (03/2020) Word Format
  • R.34.7- ABN - Instructions-Proper Use
  • R.34.8- ABN - Interactive Tutorial
  • R.35.1- Claim Adjustment Reason Codes
  • R.35.2- Remittance Advice Remark Codes
  • R.35.3- Noridian Medicare Denial Code Resolutions Tools
  • R.36.1- Brovana Rebate
  • R.37.1- External Infusion Drug Calculators
  • R.37.2- Nebulizer Drug Calculators
  • R.37.3- Enteral Nutrition Calculators
  • R.38.1- FDA Lookup Tool for NDC Codes
  • R.39.1- X12Remittance Advice Remark Codes: Understand the codes that show up on your remittance advice
  • R.39.2- X12 Claim Adjustment Reason Codes: Understand the codes that show up on your remittance advice
  • R.39.3- 2022 DSMT Diabetes Self Management Training/Education Allowable and Coverage Information
  • R.39.4- 2022 MNT Medical Nutrition Therapy Allowable and Coverage
  • R.39.5- 2023 3rd Quarter CLIA Waived Laboratory Fee Schedules
  • R.39.6- NDC Codes List and HCPCS Crosswalk
  • R.39.7- Seasonal Influenza Vaccine Pricing (Admin Fees will be applied in addition to these rates)
  • R.39.8- Other Medicare Part B Vaccine Allowables
  • R.39.9- Vaccine Administration Locality Codes (to be used with the Vaccine Administration Fee Schedule)
  • R.39.10- 2023-2024 Vaccine Administration Fee Schedule
  • R.39.11- COVID Vaccine Reimbursement
  • R.39.12- 2022 Monkey Pox Administration National Payment Allowable (Regionally Adjusted)
  • R.39.13- CMS Drug Spending Dashboards - Medicare Part D, Medicare Part B, Medicaid, and Part D Rebate Summary
  • R.39.14- All CMS Drug Fee Schedule ASP Pricing Files (Medicare Part B Drug Allowables)
  • R.39.15- 2023 3rd Quarter Inhalation Drug Quick Reference Guide
  • R.39.16- 2023 4th Quarter Inhalation Drug Quick Reference Guide
  • R.39.17- 2022 3rd Quarter Oral Anti Cancer Drug Fee Schedule
  • R.39.18- 2022 Parenteral and Enteral Nutrition Fee Schedule
  • R.39.19- Texas Medicaid Fee Schedule Lookup Tool
  • R.39.20- Medicare DME Fee schedule Look Up Tool

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