Medicare Part B Newsline March 2012 - Cahaba GBA

Using the Interactive Voice Response (IVR) System for Claim Status andEligibility RequestsCahaba Government Benefit Administrators®, LLC is experiencing a high volume of providers who areopting out of the Interactive Voice Response (IVR) system to speak to a Customer Service Representative(CSR) for information that can be accessed through the IVR.The Centers for Medicare and Medicaid Services (CMS) Internet Only Manual (IOM) Chapter 6 Section50.1 states:“Providers shall be required to use IVRs to access claim status and beneficiary eligibilityinformation. CSRs shall refer providers back to the IVR if they have questions about claims statusor eligibility that can be handled by the IVR. CSRs may provide claims status and/or eligibilityinformation if it is clear that the provider cannot access the information through the IVR because theIVR is not functioning.”If you are requesting whether Cahaba has received a claim or if a claim has finalized, this isconsidered a claim status request.In addition, according to IOM Chapter 6 Section 80.3.4, “If a CSR or written inquiry correspondent receivesan inquiry about information that can be found on a Remittance Advice (RA), the CSR/correspondentshould take the opportunity to educate the inquirer on how to read the RA, in an effort to encourage the useof self-service. The CSR/correspondent should advise the inquirer that the RA is needed in order to answerany questions for which answers are available on the RA. Providers should also be advised that any billingstaff or representatives that make inquiries on his/her behalf will need a copy of the RA.”Cahaba CSRs have visibility as to the path the provider takes in the IVR and/or whether they opt out tospeak with a representative up front. The CSR will instruct the provider to call back and utilize the IVR ifthey did not attempt to use this self service option as required by CMS.Provider Contact Center (PCC)Medicare B Newsline March 2012 6