National Government Services Connex Quick Steps

Transcription

1 National Government Services Connex Quick Steps Table of Contents Table of Contents... 1 Detailed Setup Instructions... 3 Detailed setup instructions for new Connex users are available by going to and selecting Connex Creating A User Account... 3 Logging In... 3 Resetting Your Password... 4 Retrieving Your User ID... 4 Logging Out... 4 Requesting Data Access... 4 Requesting Data Access for Multiple Accounts... 5 Viewing Your Provider Account Profile(s)... 5 Claims Query... 6 Viewing Beneficiary Entitlement Information... 6 Print Eligibility Information... 6 Patient Status (Only available for Part A Suppliers)... 7 Same or Similar and CMN Detail (Only available for DME MAC Suppliers)... 7 Check Query... 8 Editing Your Profile... 8 Changing Your Password... 8 Editing Your Data Access... 9 Requesting LSO Access (LSOs Only)... 9 Approving Data Access Requests (LSOs Only) Declining Data Access Requests (LSOs Only) Modifying Data Access (LSOs Only) Removing Data Access (LSOs Only) Unlocking User Accounts (LSOs Only) Setting Default LSO Values Initiate Redetermination or Reopening... 11

2 Check Reopening or Redetermination Status Create AR Submissions For Part A only Submit Draft AR Submissions For Part A only View Submission History For Part A only Obtain Financial Claim Number (FCN) Information Part B only Obtain Offset Information DME only Recertify LSO (Local Security Officer) Recertify LSO Provider Accounts Submit an Inquiry Review Response for an Inquiry Obtain a copy of an Inquiry Submit Advanced Determination of Medicare Coverage (ADMC) requests View Advanced Determination of Medicare Coverage (ADMC) History Submit Prior Authorization Requests for Power Mobility Demonstration (PMD) View Prior Authorization Request for Power Mobility Demonstration (PMD) History Submit a Claim - Part B only Submit Documents to Respond to an Additional Documentation Request (ADR) DME only View Additional Documentation Request (ADR) History View Remittance Advice Part B only Submit Part B Respond to Additional Documentation Request (ADR) form Part B only My Audit Dashboard DME only Submit/Edit Documentation Pre-Validation Form Requests Part B and DME only View Documentation Pre-Validation Form Part B and DME only Submit Active ERR Policies form DME only Submit Positive Airway Pressure Device form DME only National Government Services, Inc. Page 2 of 28

3 Detailed Setup Instructions Detailed setup instructions for new Connex users are available by going to and selecting Connex. Creating A User Account 1. Access National Government Services Connex at 2. Read the standard disclaimer and click the I Agree button to continue. 3. Click the New User link on the log in screen. 4. Read the Online Services & Web Confidentiality Agreements and click on the check box at the end that reads, I have read and understand the above statements. Then click on the I Agree button to continue. 5. Enter your name in the First Name/Last Name fields. 6. Enter your address in the field. 7. Click the arrow on the Time Zone field and choose your local time zone from the list. 8. Create your ID by entering it in the User ID field. 9. Create your password by entering it in both the Password and Verify Password fields. 10. Click the arrow on the Challenge Question field and choose your challenge question. 11. Enter the answer to your challenge question in the Answer to Challenge Question field. 12. Click the Next button to continue. 13. Click the Return to Welcome and Login Page link on the Thank You page. Note: If a Connex account has not been used within the last 60 days, the account will be suspended. Once an account has been suspended, the user will be required to request reactivation of their account through the Provider/Supplier Contact Center. To reactivate the user account you will need to provide your user ID and associated National Provider Identifier (NPI), Provider Transaction Account Number (PTAN) and the last five digits of your Tax Identification Number (TIN). If this information is not available or cannot be confirmed, your account will not be reactivated and a new account will need to be created. Logging In 1. From the Home page, enter your ID in the User ID field. 2. Enter your password in the Password field. 3. Click the OK button. National Government Services, Inc. Page 3 of 28

4 Resetting Your Password 1. Click the Forgot Your Password? link. 2. Enter your user ID in the User ID field and your address in the Address field and click the Submit button. 3. Enter the answer to your challenge question in the Answer to Challenge Question field. 4. Click the Submit button. 5. A temporary password will be generated. Make note of this password as you will need it to log into the system. 6. Click the Continue button to return to the Home page. 7. Upon logging into the system with your temporary password, follow the prompts to create a new password. Note: Users will be locked out of their account for three hours, if after inputting their password incorrectly three (3) times. Once the three hour window has passed, the user can then reset their password using the steps above. Retrieving Your User ID 1. Click the Forgot Your User ID? link. 2. Enter your address in the Address field. 3. Click the Submit button. (This request may take a while.) 4. Your User ID will be sent to the used during registration via Return to the Home page and enter this User ID and corresponding Password. Logging Out Follow the step below. 1. When you are ready to exit the system, click the Log Out link which is located in the upper right corner of the page. Requesting Data Access 1. Click the My User Profile tab. 2. In the System Access panel, click the New button. 3. Enter your National Provider Identifier (NPI), Provider Transaction Access Number (PTAN) and Tax Identification Number (TIN) in the associated fields. 4. Enter your customer service number (CSN) in the CSN field (this number will be provided to you by your local security officer [LSO]). 5. Select your line of business and state in the proper selection boxes. 6. Click the checkboxes for the items you are requesting access to. 7. Click the Save button. Once you click the Save button, the request will be available for the LSO to review. National Government Services, Inc. Page 4 of 28

5 Requesting Data Access for Multiple Accounts 1. Click the My User Profile tab. 2. Click on the Show More button in the User Profile panel. 3. Click the Edit button under the User Profile panel. 4. In the Default System Access Values panel, enter values for any of the following fields that you want to be auto-populated for any accounts that will be created: NPI, PTAN, TIN, Line of Business, State, Contract, My Provider Profile (checkbox), My Claims (checkbox), My Redetermination/Reopening (this checkbox will be auto-checked when the My Claims checkbox is selected, Entitlement (checkbox), and My Financials (checkbox). 5. Click the Save button. 6. In the System Access panel, click the New button. 7. Enter your National Provider Identifier (NPI), Provider Transaction Access Number (PTAN) and Tax Identification Number (TIN) in the associated fields if it is not pre-populated. 8. Enter your customer service number (CSN) in the CSN field (this number will be provided to you by your local security officer [LSO]). 9. Select your line of business and state in the proper selection boxes if it is not pre- populated. 10. Click the checkboxes for any additional items you are requesting access to for the account. 11. Click the Save button. Once you click the Save button, the request will be available for the LSO to review. Viewing Your Provider Account Profile(s) 1. Click the My Provider Profile tab. The provider accounts you have access to will be displayed on this page. 2. If there is more than one provider account, click the Select button to view the demographic information at the bottom of the page. National Government Services, Inc. Page 5 of 28

6 Claims Query The provider accounts you have access to will be displayed on this page. 2. If there is more than one provider account, click the Select button for that account. 3. Select claims under the Claim Type drop-down and click the Go button. 4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (first initial is acceptable), and Beneficiary Date of Birth in the appropriate fields. You can narrow your search by entering from service date, to service date, and/or a claim number if you wish. 5. Click the Load Claims button. Claims that match your query will be loaded at the bottom of the page in the Claims Summary panel. The summary includes the claim number, from/to service dates, beneficiary name, claim status, submitted/billed amount, and allowed amount. To view the detail information for a claim, simply click on the claim number. You can also order a remittance for a claim by selecting it in the Claims Summary panel and clicking the Order Duplicate Remittance button. A message will confirm that the remittance order was successful. If it isn't successful, you will see an error message in this area. Viewing Beneficiary Entitlement Information 1. Select a claim on the My Claims page. 2. Click the Entitlement tab. OR 1. Click the Entitlement tab. 2. Click the Query button and enter the required information. When entering the Medicare Health Insurance Claim Number be sure to enter it exactly as it appears on their Medicare card. 3. Click the Go button. The Show More button on the right displays additional entitlement information for the beneficiary. The system will only display entitlement information when data is found for the beneficiary. To search for another beneficiary, click the Query button and enter the required information, then click the Go button. Print Eligibility Information 1. Click the Entitlement tab. 2. Select the Query button. 3. Enter the Beneficiary Medicare Number, Last Name, First Name and Date of Birth. 4. Select the Go button. 5. Beneficiary Eligibility Information will display. 6. Select the Printable View button. 7. Beneficiary Eligibility Information printable view will open. National Government Services, Inc. Page 6 of 28

7 8. Click the Print link in top right hand corner of window. Patient Status (Only available for Part A Suppliers) 1. Click the My Claims tab 2. If there is more than one provider account, click the Select button for that account. 3. In the Claims Search panel, enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY), and the To Service Date you wish to search. Note: Patient Status will be displayed for claims that have a start date equal or one day after the date entered in the To Service Date field. 4. Select the Load Patient Status button. The system will search the Common Working File (CWF) for Part A claims that match the search criteria. The following fields will be returned to the user in the Patient Status panel: Claim Type Start Date Facility Type (for Claim Types of Inpatient or Outpatient) Same or Similar and CMN Detail (Only available for DME MAC Suppliers) 1. Click the My Claims tab 2. If there is more than one provider account, click the Select button for that account. 3. Select Same or Similar in the Claim Type drop-down and click the Go button. 4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY), and HCPCS you wish to search. 5. Select the Load button The system will first search the Jurisdiction B local records. If no same or similar codes are found in the Jurisdiction B local records, the system will then search the Common Working File (CWF). The following fields will be returned to the user regardless if the system found the information in the Jurisdiction B local records or the Common Working File: Same or Similar Summary: Submitted HCPCS, Submitted Modifier, Approved HCPCS, Approved Modifier. CMN Detail: Submitted HCPCS, Submitted Modifier, Approved HCPCS, Approved Modifier, Initial Date, Recertification/Revision Date, CMN Status, CMN Status Date, Length of Need, Last Day Item Billed, Total Rental Payments, Name of Supplier, Supplier Phone Number, Supplier Number. National Government Services, Inc. Page 7 of 28

8 Check Query Click the My Financials tab. The provider accounts you have access to will be displayed on this page. 1. If there is more than one provider account, click the Select button for that account. 2. Select the check type in the Check Type drop-down and click the Go button. If you are a Part A provider, check information will automatically be displayed. You will not see a Check Type field. 3. You may search with any combination of the fields on the check search forms. You can also check the Display Last 10 Checks option (if applicable) to automatically retrieve the last ten checks. 4. Click the Search button. If you are a Part B or durable medical equipment (DME) provider, you can view the claims associated with the check by selecting the check (click on the arrow next to the check you are selecting), then click on the Load Check Claims button. The claims will load in the Claims section below the Checks list. To view the details of a specific claim, click on the Claim Number under the Claims Summary section. Editing Your Profile 1. Click the My User Profile tab. 2. In the User Profile panel, click the Edit button. 3. Update the information and click the Save button. Changing Your Password 1. Click the My User Profile tab. 2. In the User Profile panel, click the Change Password button. 3. Enter your current password in the Current Password field. 4. Enter your new password in the New Password and Verify New Password fields. 5. Click the Save button. National Government Services, Inc. Page 8 of 28

9 Editing Your Data Access 1. Click the My User Profile tab. 2. In the System Access panel, click the Edit button. 3. Update the information and click the Save button. You would use the New button in the System Access panel to request access for other provider accounts within your organization. Requesting LSO Access (LSOs Only) 1. Click the My User Profile tab. 2. In the System Access panel, click the New button. 3. Enter your NPI, PTAN, and TIN in the proper fields. 4. Select your line of business and state in the proper selection boxes. 5. Click the checkboxes for the items you are requesting access to. 6. Click the User Management checkbox. 7. Enter the check number in the Check Number field. 8. Enter the check amount (without dollar signs or commas) in the Check Amount field. If this is your first LSO request, click the Save button. You will not enter a value in the Access Code field at the time you generate the initial request (if you have no LSO.) When National Government Services approves the first LSO request for your organization, an access code will be generated and mailed to your billing address. Access codes should be received at the billing address to your attention within 7 to 10 business days. This access code will activate your LSO access. From this point forward, you can approve other LSOs and users without obtaining another access code. Once you receive the access code, complete the remaining steps: 9. Click the My User Profile tab. 10. In the System Access panel, click the Edit button. 11. Enter your access code in the Access Code field. 12. Click the Save button. National Government Services, Inc. Page 9 of 28

10 Approving Data Access Requests (LSOs Only) 1. Click the User Management tab. 2. In the System Access panel, click the arrow to the left of the user you are approving. 3. Review the System Access Detail panel and make any necessary modifications to the requested access. If you want the user to have LSO access, you can check the User Management option in this area. If you do not want them to have this access, be sure this option is not checked. 4. Click the Approve button. When you approve a data access request, the Status field will update to Approved. Declining Data Access Requests (LSOs Only) 1. Click the User Management tab. 2. In the System Access panel, click the arrow to the left of the user you are declining. 3. Click the Decline button. When you decline a data access request the Status field will update to Declined and all the options in the System Access Detail panel will be unchecked. When the LSO refreshes their User Management page, the request will disappear; however, the user will see the Declined status in their My User Profile page. Modifying Data Access (LSOs Only) 1. Click the User Management tab. 2. In the System Access panel, click the arrow to the left of the user you are modifying. 3. Make any necessary modifications to the user's access. 4. Click the Approve button. National Government Services, Inc. Page 10 of 28

11 Removing Data Access (LSOs Only) 1. Click the User Management tab. 2. In the System Access panel, click the arrow to the left of the user you are removing. 3. Click the Delete button. 4. Click the OK button in the Are You Sure? dialog box. Unlocking User Accounts (LSOs Only) If a user attempts to reset a forgotten password and answers their challenge question incorrectly three times, their account will be locked. In this situation, LSOs can unlock user accounts and create a temporary password. 1. Click the User Management tab. 2. Click the arrow next to the user who is locked and click the Reset Password button in the User Profile panel. 3. Enter the new temporary password in the Password and Verify Password fields. 4. Click the Save button and give the user the temporary password. The user will be forced to reset it when they log in. Setting Default LSO Values If a user wishes to add Default LSO values that will be applied to all LSO Approved Providers listed under the LSO user's System Access, follow the steps below. 1. Click the My User Profile tab. 2. Select 'Show More'. 3. Select 'Edit'. 4. Complete three Supervisor's fields. 5. Select 'Save'. 6. Scroll down and select 'Set LSO Recertification'. Initiate Redetermination or Reopening 2. If there is more than one provider account, click the Select button for that account. 3. Select claims under the Claim Type drop-down and click the Go button. 4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY). You can narrow your search by entering from service date, to service date, and/or a claim number if you wish. 5. Click the Load Claims button. 6. Locate the claim you wish to initiate a Redeterminations or Reopenings and click on the Claim Number. National Government Services, Inc. Page 11 of 28

12 7. Click the Initiate Redetermination/Reopening button. Part A and DME will display the Initiate Redetermination/Reopening button, Part B will display Redetermination and Reopening buttons separately. 8. Complete the Redetermination or Reopening form. All fields with red asterisk are required. NOTE: To add multiple lines from the claim on the redetermination/reopening request, click on the Claim Line Procedure Code(s) checkbox, click the New button, enter the required fields, click on the Save button. When applicable, complete the same steps to add additional lines from the claim if the redetermination/reopening request includes multiple lines from the claim selected in Connex. Once all claim lines are entered, click on the OK button to return to the form. 9. Once all required fields are completed, click the OK button. If the form continues to display on your screen, scroll to the top of the form to locate your error message, correct the error and click on the OK button again. If you see an error message, make sure that all required fields are completed. If after clicking on the OK button, the form disappears and the My Redeterminations/Reopenings tab displays, the request was received. 10. If supporting documentation needs to be included with the Redetermination, click on the New button under the attachment section to add the documentation. Note: There are no file size limitations to the attachments that can be submitted in Connex. The only file types not accepted are,.xml,.log, and.cfg. Note: Documentation will not be accepted for Part B Reopenings; if submitting documentation please submit your request as a Redetermination. Check Reopening or Redetermination Status Follow the steps below to obtain the Redetermination or Reopening status for Part B Services billed. 2. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY), Claim Number, or Correspondence Number. 3. Click the Load Redetermination/Reopening Status button. Follow the steps below to obtain the Redetermination or Reopening status for Part A Services billed. 2. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY), Document Control Number, or From and Thru Date of Service. 3. Click the Load Redetermination/Reopening Status button. Follow the steps below to obtain the Redetermination or Reopening status for DME Services billed. 2. If there is more than one provider account, click the Select button for that account. 3. Select claims under the Claim Type drop-down and click the Go button. 4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY), Claim Number, or Document Control Number. 5. Click the Load Redetermination/Reopening Status button. National Government Services, Inc. Page 12 of 28

13 The system will search for any Redetermination or Reopening that have been received for the Claim number, Correspondence Number, or Document Control Number entered. When a match is found on the Claim Number, Correspondence Number, or Document Control Number for a Reopening or Redetermination, the system will display the status of the Redetermination or Reopening found. When the review has been completed by the NGS Part A, Part B, or DME Appeals Department, the system will display a finalized status and the status description. When the review is still being conducted by the Part B Appeals Department the status will display as Pending. The review can take up to 60 days to complete. Connex will include all redeterminations/reopenings requests regardless of how they were originally initiated (written, fax, telephone or through Connex). National Government Services, Inc. Page 13 of 28

14 Create AR Submissions For Part A only 1. Click the My Financials tab. 2. Locate the Provider you wish to submit documentation for and select the Select button. 3. For the Type, select the option Audit & Reimbursement Document Submission and select the Go button. 4. In the Audit & Reimbursement Document Submission section, click the New button. 5. Enter the Fiscal Year End (Format: MM/DD/YYYY), Type of Data, Contact Address, and Purpose of Submission. Note: Please include a Contact Name within the Purpose of Submission. 6. Click on the Save button to save the submission form. 7. In the Submission Documents section, select the New button to add document files to the submission. 8. Click the small button next to the File Name. 9. In the Add Attachment - Windows Internet Explorer window, click the Browse button. 10. Select the document file you wish to attach to the submission form and click the Open button. 11. The selected file will appear within the Submission Documents window. Click the Save button. 12. Repeat steps 7-11 for all document files you wish to attach to the submission form. 13. Verify that all document files attached are listed in the Submission Documents section. Note: If a file needs to be removed from the submission, you can select the file and click the Delete button. 14. Click on the Submit button in the Audit & Reimbursement Document Submission section. Note: You will not be able to modify a submission once the Submit button has been pressed. National Government Services, Inc. Page 14 of 28

15 Submit Draft AR Submissions For Part A only 1. Click the My Financials tab. 2. Locate the Provider you wish to submit documentation for and select the Select button. 3. For the Type, select the option Audit & Reimbursement Document Submission and select the Go button. 4. The Audit & Reimbursement Document Submission section will list all draft submissions that have been started but have not been submitted. The submissions will have a Status of In Progress. 5. In the Submission Documents section, select the New button to add document files to the submission. 6. Click the small button next to the File Name. 7. In the Add Attachment - Windows Internet Explorer window, click the Browse button. 8. Select the document file you wish to attach to the submission form and click the Open button. 9. The selected file will appear within the Submission Documents window. Click the Save button. 10. Repeat steps 5-9 for all document files you wish to attach to the submission form. 11. Verify that all document files attached are listed in the Submission Documents section. Note: If a file needs to be removed from the submission, you can select the file and click the Delete button. 12. Click on the Submit button in the Audit & Reimbursement Document Submission section. Note: You will not be able to modify a submission once the Submit button has been pressed. View Submission History For Part A only 1. Click the My History tab. 2. Locate the Provider you wish to view submission documentation for and select the Select button. 3. The Submission History section will contain all submissions that have been successfully submitted. 4. If you would like to see a particular submission, you can select the Query button and supply Fiscal Year End (Format: MM/DD/YYYY), Type of Data, Contact Address, and/or Submission Date (Format: MM/DD/YYYY) to search upon. Note: You can also select the Query button on the Submission Documents section and supply a File Name to search upon. 5. Locate and select the submission you want to view. The Submission History section will show information about the submission and the Submission Documents section will show the files attached to the submission. Note: The information displayed on this screen will not be updateable. National Government Services, Inc. Page 15 of 28

16 Obtain Financial Claim Number (FCN) Information Part B only 1. Click the My Financials tab. 2. Locate the Provider you wish to view Financial Claim Number (FCN) Information for and select the Select button. 3. Locate the Check Type field and select the Financial Claim Number (FCN) Claim Detail Search or the Financial Claim Number (FCN) Patient Search option needed and select the Go button. Note: You will be prompted for specific information based on the Financial Claim Number (FCN) search option you select. 4. When selecting the Financial Claim Number (FCN) Claim Detail Search, enter the fifteen digit (15) Financial Claim Number (FCN), Beneficiary Medicare Number, Beneficiary Last Name, and Beneficiary First Name. When selecting the Financial Claim Number Patient Search, enter the fifteen digit (15) Financial Claim Number (FCN). Note: The system will display detailed claim information when selecting the Financial Claim Number (FCN) Claim Detail Search. Patient information will be displayed when selecting the Financial Claim Number (FCN) Patient Search. 5. Select the Search button. The system will search for information on file for the Financial Claim Number (FCN) Information entered. The system will provide a notification when no match is found for the Financial Claim Number (FCN) Information entered. Obtain Offset Information DME only 1. Click the My Financials tab. 2. Locate the Provider you wish to view Offsets Information for and select the Select button. 3. Select offsets under the Check Type drop-down and click the Go button 4. Enter the fifteen digit (15) FCN - Financial Control Number. 5. Select the Search button. The system will search for information on file for the Financial Control Number (FCN) entered. The system will provide a notification when no match is found for the Financial Control Number (FCN) entered. National Government Services, Inc. Page 16 of 28

17 Recertify LSO (Local Security Officer) **National Government Services will communicate the Annual Recertification time period** Follow the steps below. 1. Click the My User Profile tab. 2. If there is more than one provider account, the LSO will locate the Provider Account where they are the LSO and select the Edit button on the System Access Detail. 3. The LSO will complete the fields located under the Fields for Local Security Officer (LSO) Recertification section and select the Save button. The following fields should be completed by the LSO: a. My Supervisor Name b. My Supervisor s Street Address 1 c. My Supervisor s Street Address 2 d. My Supervisor s City e. My Supervisor s State f. My Supervisor s Zip g. My Supervisor s Address h. My Supervisor s Telephone Number Note: An will be sent to the LSO s supervisor address 4. The LSO s Supervisor will receive notification from National Government Services with the LSO Recertification Code needed to complete the Recertification process. 5. Upon receiving the LSO Recertification Code the LSO selects the My User Profile tab, if there is more than one provider account, the LSO will locate the Provider Account where they are the LSO and select the Edit button on the System Access Detail section. 6. The LSO will enter the LSO Recertification Code under the Fields for Local Security Officer (LSO) Recertification section and select the Save button. National Government Services, Inc. Page 17 of 28

18 Recertify LSO Provider Accounts Follow the steps below to Recertify Provider Accounts. 1. Click the User Management tab. 2. If there is more than one provider account, click the Select button for that account. 3. To Recertify the Provider Account, select the Recertify button. Connex will capture the date and time the Provider Account was recertified. Submit an Inquiry 1. Click the My Inquiries tab. 2. If there is more than one provider account, click the Select button for that account. 3. Select the Initiate button under the Inquiries section. 4. Complete the form and ensure all fields that are denoted by red asterisks (required fields) are entered and select the Save button. When there is missing information found on the form, the system will prompt a message indicating the data that is missing. 5. If supporting documentation should be included with the inquiry, select the New button under the Inquiries Attachments section. Select the Checkmark button next to the File Name field to locate and attach the document(s). Select the Save button when you have finished adding the documentation. 6. To submit the inquiry, select the Submit button under the Inquiries section. Note: The Inquiry will not be sent to National Government Services until the submit button is selected. Note: An acknowledgment will be sent from National Government Services to the individual initiating the inquiry once it is submitted. Review Response for an Inquiry *** When National Government Services has a response to provide for an Inquiry submitted, an will be sent to the address we have on file for the user that submitted the Inquiry.*** Follow the steps below to review the response. 1. Click the My Inquiries tab. 2. If there is more than one provider account, click the Select button for that account. 3. In the Inquiries section, select the Electronic Inquiry ID that you wish to review. 4. Review the response located under the Inquiries Notes Section. Note: The Inquiry Notes section will not be displayed until a response is sent from National Government Services. 5. If your inquiry has not been completed/cancelled by National Government Services and you would like to submit a response, select the New button under the Inquiry Notes section and add your response to the Response Description section and select the Save button. 6. If supporting documentation should be included with your response, select the New button under the Inquiries Attachments section. Select the Checkmark button next to the File Name field to locate and attach the document(s). Select the Save button when you have finished adding the documentation. 7. To submit your response Select the Submit button under the Inquiry Notes section. National Government Services, Inc. Page 18 of 28

19 Note: When your inquiry has been completed/cancelled by National Government Services. You will not be able to submit additional responses for the inquiry. A new Inquiry will need to be submitted to address any questions regarding an inquiry that has been completed/cancelled. Obtain a copy of an Inquiry 1. Click the My Inquiries tab. 2. If there is more than one provider account, click the Select button for that account. 3. In the Inquiries section, select the Inquiry PID that you wish to review. 4. Select the Create Inquiry Attachment button under the Inquiries section. 5. To view a copy of the Inquiry go to the Inquiry Attachments section and select the file that has _Inquiry Form in the File Name for the date and time the Create Inquiry Attachment button was selected. Note: The file copy will contain the details of the Inquiry to include: the Inquiry Detail Section, Inquiry Notes, and Inquiry Attachments information at the time the Create Inquiry Attachment button was selected. Submit Advanced Determination of Medicare Coverage (ADMC) requests 2. If there is more than one provider account, click the Select button for the appropriate provider account. 3. Select Advance Determination of Medicare Coverage under the Claim Type drop-down and click the Go button. 4. Select the New button under the Advance Determination of Medicare Coverage section. The Advance Determination of Medicare Coverage form will be displayed. 5. Complete the Advance Determination of Medicare Coverage form. All fields with red asterisks are required. 6. Click the Save button. 7. Select the New button under the Attachments section and add all necessary supporting documentation. Browse for the appropriate attachment by clicking on the box next to the Attachment Name field, click on the Add button, and then click on the Save button. Complete these steps for each attachment. Attachments can be deleted prior to selecting the Submit button. Note: There are no file size limitations to the attachments that can be submitted. Types of files NOT accepted are.xml,.log and.cfg. 8. Once attachments have been added, the Submit button on the Advance Determination of Medicare Coverage section will be enabled. Select Submit button to send the request to National Government Services. Note: The request is not sent to National Government Services until the Submit button is selected. Once the request is submitted, it will display under the My History tab within Connex. National Government Services, Inc. Page 19 of 28

20 View Advanced Determination of Medicare Coverage (ADMC) History 1. Click the My History tab. 2. If there is more than one provider account, click the Select button for the appropriate provider account. 3. The Submission History section will display all requests that have been successfully submitted in Connex. 4. To view a particular submission, select the record to view by clicking on the arrow to the left hand side of the request. You can also select the Query button to search for a specific request. 5. The Submission History section will show information about the submission. The Submission Documents section will show the files attached to the submission. Note: The information on this screen cannot be edited or updated. Submit Prior Authorization Requests for Power Mobility Demonstration (PMD) 2. If there is more than one provider account, click the Select button for the appropriate provider account. 3. Select Prior Auth. For Power Mobility Demonstration under the Claim Type drop-down and click the Go button. 4. Select the New button on the Prior Authorization Request for Power Mobility Demonstration section. The Prior Authorization Request for Power Mobility Demonstration form will be displayed. 5. Complete the Prior Authorization Request for Power Mobility Demonstration form. All fields with red asterisks are required. 6. Click the Save button. 7. Select the New button under the Attachments section and add all necessary supporting documentation. Browse for the appropriate attachment by clicking on the box next to the Attachment Name field, click on the Add button, and then click on the Save button. Complete these steps for each attachment. Attachments can be deleted prior to selecting the Submit button. Note: There are no file size limitations to the attachments that can be submitted. Types of files NOT accepted are.xml,.log and.cfg. 8. Once attachments have been added, the Submit button on the Prior Authorization Request for Power Mobility Demonstration section will be enabled. Select Submit button to send the request to National Government Services. Note: The request is not sent to National Government Services until the Submit button is selected. Once the request is submitted, it will display under the My History tab within Connex. National Government Services, Inc. Page 20 of 28

21 View Prior Authorization Request for Power Mobility Demonstration (PMD) History 1. Click the My History tab. 2. If there is more than one provider account, click the Select button for the appropriate provider account. 3. The Submission History section will display all requests that have been successfully submitted in Connex. 4. To view a particular submission, select the record to view by clicking on the arrow to the left hand side of the request. You can also select the Query button to search for a specific request. 5. The Submission History section will show information about the submission. The Submission Documents section will show the files attached to the submission. Note: The information on this screen cannot be edited or updated. Submit a Claim - Part B only 2. If there is more than one provider account, click the Select button for the Part B Provider which has an EDI agreement on file. 3. Select Claims Entry in the Claim Type drop down and click the GO button. 4. Click the New button for entering a new claim. 5. Enter required fields for Beneficiary information. 6. If you select Yes for Medicare is Primary, the Insured information fields will prepopulate (Name, DOB, and Address). 7. If Medicare is NOT Primary, please file your claim via the paper mailing process. We are not accepting MSP claims through Connex at this time. 8. Select appropriate Accept Assignment: Yes or No. 9. Select appropriate Signature on File: Yes or No. 10. Enter Diagnosis in Diagnosis of Illness field. 11. Select Yes or No in drop down box for Supporting Document on File. 12. Click check mark button under Claim Details. 13. Claim Detail information window will open. 14. Click the New button on the Claim Detail Information screen and enter required fields. 15. Click the Save button to save claim detail information. 16. Click OK on Claim Detail Information window to close. 17. Click the Save button on Claim Entry Screen. Note: If there are claim errors, the screen will prompt to correct errors. Once the claim is saved, user can Edit, Delete, or Submit the Claim. 18. Click Submit button on Claim Entry Screen. Note: Once claim has been submitted, the Edit, Delete and Submit button will be disabled. 19. Once claim is submitted, Claim Status will be Submitted Validating. National Government Services, Inc. Page 21 of 28

22 20. For successful claim submission, claim status will change from Submitted Validating to Accepted Processing. 21. For un-successful claim submission, claim status will change from Submitted-Validating to Failed-Error(s) Found. Submit Documents to Respond to an Additional Documentation Request (ADR) DME only 2. If there is more than one provider account, click the Select button for the appropriate provider account. 3. Select Claims under the Claim Type drop-down and click the Go button. 4. Enter Beneficiary Medicare Number, Last Name, First Name, and Date of Birth information and click Load Claims button. 5. Click desired claim number. 6. Select Respond to Additional Documentation Request button under Claim Header. 7. Complete the Additional Documentation Request form. All fields with red asterisks are required. 8. Click the Save button. 9. Select the New button under the Attachments section and add all necessary supporting documentation. Browse for the appropriate attachment by clicking on the box next to the Attachment Name field, click on the Add button, and then click on the Save button. Complete these steps for each attachment. Attachments can be deleted prior to selecting the Submit button. Note: There are no file size limitations to the attachments that can be submitted. Types of files NOT accepted are.xml,.log and.cfg. 10. Once attachments have been added, the Submit button on the Additional Documentation Request section will be enabled. Select Submit button to send the request to National Government Services. Note: The request is not sent to National Government Services until the Submit button is selected. Once the request is submitted, it will display under the My History tab within Connex. View Additional Documentation Request (ADR) History 1. Click the My History tab. 2. If there is more than one provider account, click the Select button for the appropriate provider account. 3. The Submission History section will display all requests that have been successfully submitted in Connex. National Government Services, Inc. Page 22 of 28

23 4. To view a particular submission, select the record to view by clicking on the arrow to the left hand side of the request. You can also select the Query button to search for a specific request. 5. The Submission History section will show information about the submission. The Submission Documents section will show the files attached to the submission. Note: The information on the screen cannot be edited or updated. View Remittance Advice Part B only 2. If there is more than one provider account, click the Select button for the appropriate provider account. 3. Select Claims under the Claim Type drop-down and click the Go button. 4. Enter Beneficiary Medicare Number, Last Name, First Name, and Date of Birth information and click Load Claims button. 5. Double-Click on hyperlink of desired claim number to Claim Details view. 6. Select Remittance View button under Claims Header. 7. The remittance advice for the beneficiary and claim selected shall be displayed. 8. Select the Print option to print remittance advice displayed. Submit Part B Respond to Additional Documentation Request (ADR) form Part B only 2. If there is more than one provider account, click the Select button for the appropriate provider account. 3. Select Claims under the Claim Type drop-down and click the Go button. 4. Select Respond to Additional Documentation Request button under Claim Header. 5. Complete the Additional Documentation Request form. All fields with red asterisks are required. (Note: To determine and/or locate your MR Letter number, please refer to the following example.) National Government Services, Inc. Page 23 of 28

24 Example of where you can find the letter number Click the Save button. 8. Select the New button under the Attachments section and add all necessary supporting documentation. Browse for the appropriate attachment by clicking on the box next to the Attachment Name field, click on the Add button, and then click on the Save button. Complete these steps for each attachment. Attachments can be deleted prior to selecting the Submit button. Note: There are no file size limitations to the attachments that can be submitted. Types of files NOT accepted are.xml,.log and.cfg. 9. Once attachments have been added, the Submit button on the Additional Documentation Request section will be enabled. Select Submit button to send the request to National Government Services. Note: The information on the screen cannot be edited or updated. National Government Services, Inc. Page 24 of 28

25 My Audit Dashboard DME only 2. If there is more than one provider account, click the Select button for the appropriate provider account. 3. Select My Audit Dashboard under the Claim Type drop-down and click the Go button. 4. If available, the following categories and corresponding totals will be displayed: a. NGS Audited (Total) b. NGS Audited Denied (Total) c. CERT Audited (Total) d. CERT Audited Denied (Total) e. RAC Audited (Total) f. SMRC Audited (Total) g. SMRC Audited Denied (Total) 5. If desired, select ADR Letter option to view ADR letter verbiage for any record in the NGS Audited Claim Summary category. Submit/Edit Documentation Pre-Validation Form Requests Part B and DME only The Documentation Pre-Validation Form is available for Part B Physicians and DME Suppliers to ensure they are meeting the documentation requirements when initially prescribing or providing home oxygen. The pre-validation form will ask series of questions based on the documentation for portable and/or stationary oxygen. Once the form is submitted, it will validate against the most common errors and provide an immediate decision on whether or not the documentation meets Medicare s guidelines. An approved or rejected decision will be received by the user, along with a reason(s) for the rejected decision and specific education to assist in correcting the error. 2. If there is more than one provider account, click the Select button for the appropriate provider account. 3. Select Documentation Pre-validation from the Claim Type drop-down and click the Go button. 4. Select the appropriate option for the type of oxygen being prescribed/provided under the Type of Validation drop-down and click the Go button. 5. Under the Physician Documentation Pre-validation (Part B) or Supplier Documentation Pre-validation (DME) section, click the New button. 6. Complete the form. Required fields are indicated with the red asterisk. 7. Click the Save button. National Government Services, Inc. Page 25 of 28

26 8. If an error message is received (indicated in red font at the top of the form), correct the error and select the Save button until no errors are received and the Submit button is active. 9. Select the Submit button to send the request. Once the request is submitted, it will validate against the most common errors and provide an immediate decision on whether or not the documentation meets Medicare guidelines. 10. The result determination will be provided in the Physician Type of Validation Selection History (Part B) or Supplier Type of Validation Selection History (DME) section under the Result Determination field. Be sure to highlight the correct submission by clicking on the arrow to the left of the request to view the form and pre-validation rejected results. 11. If a Rejected result determination is received, the result code(s) and result description(s) are displayed in the Pre-validation Rejected Results section. The result description(s) provide the reason for the rejection. Connex users may edit the form and resubmit. a. To edit the form, select the Edit button. b. Update the form as needed and select the Save button. c. If an error message is received (indicated in red font at the top of the form), correct the error and select the Save button until no errors are received and the Submit button is active. d. Select the Submit button to send the request. Once the request is submitted, it will validate against the most common errors and provide an immediate decision on whether or not the documentation meets Medicare guidelines. The Transaction ID will remain the same as the request originally submitted, but the Date/Time stamp will change. 12. If an Accepted result determination is received, nothing will display in the Pre-validation Rejected Results section. The Supplier/Physician Type of Validation Selection History section will display the approved outcome under the Result Determination field. Please note the Pre-Validation form is an educational feature designed to assist with documentation compliance on the initial issuance of oxygen. The question set focuses on areas with high error rates and the question set is not all inclusive of Medicare requirements. View Documentation Pre-Validation Form Part B and DME only 2. If there is more than one provider account, click the Select button for the appropriate provider account. 3. Select Documentation Pre-validation from the Claim Type drop-down and click the Go button. 4. Select the appropriate option for the type of oxygen being prescribed/provided under the Type of Validation drop-down and click the Go button. 5. Click the arrow to the left of the request under the Physician Type of Validation Selection History (Part B) or Supplier Type of Validation Selection History (DME) section to view the details of the submission. National Government Services, Inc. Page 26 of 28

27 Note: The Physician/Supplier Type of Validation Selection History will only display submissions based on the Type of Validation selected at the top of the screen. Submit Active ERR Policies form DME only 2. If there is more than one provider account, click the Select button for the appropriate DME provider account. 3. Select Claims under the Claim Type drop-down and click the Go button. 4. Select the Active ERR Policies selection. 5. Select the New button under the Active ERR Policies label. 6. Complete the Active ERR Policies form. All fields with red asterisks are required. 7. Click Save button. 8. Select the New button under the Attachments section and add all necessary supporting documentation. Browse for the appropriate attachment by clicking on the box next to the Attachment Name field, click on the Add button, and then click on the Save button. Complete these steps for each attachment. Attachments can be deleted prior to selecting the Submit button. Note: There are no file size limitations to the attachments that can be submitted. Types of files NOT accepted are.xml,.log and.cfg. 9. Once attachments have been added, the Submit button on the Active ERR Policies button will be enabled. Select Submit button to send the request to National Government Services. Note: The request is not sent to National Government Services until the Submit button is selected. Once the request is submitted, it will display under the My History tab within Connex. Submit Positive Airway Pressure Device form DME only 2. If there is more than one provider account, click the Select button for the appropriate DME provider account. 3. Select Claims under the Claim Type drop-down and click the Go button. 4. Select the Positive Airway Pressure Device selection. 5. Select the New button under the Positive Airway Pressure Device label. 6. Complete the Positive Airway Pressure Device form. All fields with red asterisks are required. 7. Click Save button. 8. Select the New button under the Attachments section and add all necessary supporting documentation. Browse for the appropriate attachment by clicking on the box next to the National Government Services, Inc. Page 27 of 28