Medicare Compliance & Reimbursement

If you need information from your Medicare Administrative Contractor (MAC) about your claims, make sure you have all your paperwork and credentials in hand — because the MACs are tightening their authentication requirements.

Details: To better safeguard Medicare providers’ and beneficiaries’ privacy, the Centers for Medicare & Medicaid Services (CMS) is requiring “certain elements” of authentication before MACs can release claims information, says Part B MAC CGS Medicare in a Feb. 2 alert.

“Beginning May 1, 2023, claim- and eligibility-specific calls received in the Provider Contact Center (PCC) that are not properly authenticated will be transferred back to the [Computer Telephony Integration] CTI line to complete this required step,” CGS warns.

Depending on the inquiry, you will need the following materials to complete the authentication process, according to CGS guidance:

• Provider National Provider Identifier (NPI);
• Provider Transaction Access Number (PTAN);
• The last five digits of the provider Tax Identification Number (TIN);
• Beneficiary’s Medicare Beneficiary Identifier;
• The first six letters of the beneficiary’s last name;
• The first letter of the beneficiary’s first name; and
• The beneficiary’s date of birth.

Find more information, including how to determine if your question is claim-specific or general, at https://cgsmedicare. com/partb/pubs/news/2016/04/cope32689.html.