billing the dmercs and others for infusion pumps - ION Solutions

RESPONDING TO REQUESTS (CIGNA)Below are important TIPS for handling the requests: Read each request letter carefully. Note the due date given in the letter. (Denials will often occur if a response is not receivedwithin the stated timeframe.) Note where to send your response and be sure to respondto the correct office. (Delays andpossible denials will occur if you respond to the wrong office.) For prepayment claims, put the request letter on top of the documents you include in yourresponse. This helps ensure your documents are routed appropriately when received at thecontractor. (Prepayment means the claim has not completed processing yet.) Respond only one time. Don’t send your response multiple times.Do not combine responses. If the request letter asks for documentation on just one claim, onlyinclude documentation for that claim in your response. Send all documents for your response at one time. Don’t send part now and part later. Do not file duplicate claims. Keep track when you have received a request for additionaldocumentation on a prepayment claim. Do not file another claim for the same items justbecause you have not received a response as quickly as a claim where documentation was notrequested. Remember the contractors normally have longer time limits to review claims where additionaldocumentation was requested. Time limits will vary depending on the contractor, butgenerally the Centers for Medicare & Medicaid Services (CMS) allows at least 60 days forcontractors to complete the reviews once the documentation/records are received. Each of these contractors has a website, so information is easily accessible about each one.Visit the CGS website at: http://www. cignagovernmentservices.com/jc/index.html under theCustomer Service/Helpful Links section for links to the other contractors. Following is a link to a Medicare Claim Review Programs booklet from the Centers forMedicare & Medicaid Services (CMS) which may also provide helpful information for you:http://www.cms.hhs. gov/MLNProducts/downloads/MCRP_Booklet.pdf.