J15 CGS Administrators, LLC: Kentucky Medicare

CGS Administrators, LLC (CGS) administers Medicare health insurance for the Centers for Medicare and Medicaid Services (CMS) for Jurisdictions 15, which includes the state of Kentucky. If you are a provider located in the State of Kentucky and need to become an electronic submitter for your Medicare A/B Claims, please follow the enrollment instructions below. 

 

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed prior to initiation of electronic claims submission.

1. EDI Enrollment Packet

To obtain the forms above, please download them from:
http://www.cgsmedicare.com/hhh/edi/index.html

 

Click on EDI on the left hand side, then click on EDI Enrollment Packet If you have any questions regarding any of the documents in this package, please call the CGS EDI Technology Support Center for your line of business: Part A 1-866-590-6703 or Part B 1-866-276-9558.

 

Please Note: You have to use Internet Explorer when opening the enrollment packet in order for the applications to appear as attachments on the left hand side.

 

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

 

EDI Application

Section 1

  • Select your Line of Business

  • Choose “Apply for New Submitter ID”

    • New applicants should leave the Submitter ID line blank.

  • Please enter your Business or Provider Name as the Owner Name

  • Type of Submitter: Choose Provider or Billing Service (if YOU are a billing service)

  • Please complete your demographic and contact information

  • For Claim Submission choose GPNet Asynchronous

  • For Report/Electronic Remittance choose GPNet Asynchronous

  • Report Response Format choose File

  • Data Compression choose PKZip

  • For Name of Software Vendor please enter the name of the Software or Vendor that creates our 837 files you need Claimshuttle to transfer for you. If you have paid for our SolAce billing software please call our support line for our SolAce software information.

  • Enter N/A under Vendor Security ID

Section 2

  • If you are the Provider or Entity Owner and You will be submitting your own claims then enter your information in the “Providers for Whom Submitter Will Be Transmitting”.

    • Choose “Yes” for “Provider Authorization Form Attached?”

    • Check the boxes for “Submit Claims, Receiver Reports, and Receive Electronic Remittances (EOBs)”.

    • If you would like access to the Online Inquiry Services please also check that box and ask us about our pricing through ClaimShuttle Service so you may get you logged in to the FISS/DDE system for CGS!

  • If there are other providers in your practice for whom you will be billing, complete the other sections with their information, and choose the same options.

 

EDI Enrollment Agreement

  • Complete Section C with your information

 

Provider Authorization Form

  • Each provider that you will be billing for via the Submitter ID that you will be applying for must complete this form.

    • Choose the appropriate State & Line of Business

    • Complete the Provider Information section.

    • Provider must complete and sign this form

 

EDI Online Inquiry Services

If you chose to mark the box in the EDI Application for access to the Online Inquiry system, please complete this form with your information. Otherwise, please skip this form.

Please disregard the Software Order form that comes with the packet unless you are interested in Medicare's PC Ace Pro-32 Software.

If you are in need of an electronic billing software please inquire about our user friendly SolAce EMC software which you can use for all of your electronic billing needs.

 

Submitting your Forms

It is recommended that you keep a copy of these forms for your records and if sending by mail, be sure to send documents with original signatures to:

 

J15- Part B Correspondence
CGS
PO Box 20018
Nashville, TN 37202
 

*Faxing is recommended for faster service

 

OH Part A: 615-664-5945
OH Part B: 615-664-5927
KY Part A: 615-664-5943
KY Part B: 615-664-5917
HHH: 615-664-5947
 

Waiting for a Response

After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center toll-free at the number for your line of business: Part A 1-866-590-6703 or Part B 1-866-276-9558

 

Testing

Once you have received your Submitter ID and Password from CGS, please call the Claimshuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to NGS.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.