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Overview of Medicare Contract Transition for Jurisdiction B from NGS to CGS

Provided by Region B Council January 27, 2016 When the Jurisdiction B contract was re-bid by CMS, it was awarded to CGS (the contractor for Jurisdiction C). NGS, the current contractor, filed an appeal, and it was denied. The contract is transitioning to CGS. The current timeline is for a June 24th/June 27th cut-off date. NGS will process all claims submitted thru Friday, June 24th; CGS will take over processing as of Monday, June 27th.

  • The transition for actual claims processing should go smoothly, and basically be transparent to providers.
  • All electronic claims go thru the CEDI gateway. Providers will use the same submitter/transmitter numbers. CEDI will (electronically) look at the claim file, and stream it to CGS rather than NGS.
  • Providers should not have to do any updates to EFTs and ERNs.
  • There will be a transition time frame where NGS will continue to work the claims that they received prior to the cut-off date. After some time – CMS will set this date – NGS will stop work and pass all open claims over to CGS.

Any claims denied June 27, 2016 or after will go to CGS for appeal. A similar process will happen with open appeals, PA requests, etc. Providers will send them to NGS until June 24, 2016; then send to CGS as of June 27, 2016. NGS will work thru their workload for those activities until a later date (to be announced); at that time, any open activities will be sent over to CGS for completion. Anything mailed for Jurisdiction B will go to the new addresses as of June 27, 2016. CGS is hoping to be able to transfer the current Jurisdiction B customer service/IVR phone lines, but if that doesn’t happen, providers can expect new phone numbers to call. The Jurisdiction B website maintained by NGS will go away. CGS will add Region B to their current Region C website (www.cgsmedicare.com). Same with the Provider Portals: NGS’ Connex will go away; providers will access Jurisdiction B information using CGS’ portal, myCGS - see: http://www.cgsmedicare.com/jc/mycgs/index.html CGS will import and have available as much history on Jurisdiction B claims as they can. It’s a little hard to grasp this, but even though the same contractor – CGS – will be managing both the Jurisdiction B and Jurisdiction C contracts, they will remain two different Jurisdictions. So, as an example, when providers check same/similar for a customer who lives in Jurisdiction B, results will return only from Jurisdiction B. There will be a new Medical Director for Jurisdiction B: Dr. Doran Edwards. He is currently a supporting Medical Director for CGS. CGS is hiring approximately 150 new staff in the Nashville area, where their operations are based. CGS was represented at the Region B Council meeting last week. They stated that they value the activity and communication with the Councils, and – at least for now – expect to continue to participate in both Jursidiction C and Region B Councils, separately. We don’t know where the Region B Council will meet, but all agreed that there are significant advantages to in-person meetings rather than teleconferences. CGS has created an implementation website: www.cgsmedicare.com/jb They also have an Implementation Help Desk: phone 877-363-8895, open Mon – Fri 1pm – 5pm Central