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NGS: Avoid Claim Denials by Updating Provider Info for SMRC Reviews

Medicare has contracted with a Supplemental Medical Review/Specialty Contractor (SMRC) that is evaluating medical records and related documents to determine whether claims were billed in compliance with coverage, coding, payment, and billing practices.

However, some providers may not be getting the medical records because the provider address is incorrect or because they do not know about the SMRC.

New York’s Medicare Administrative Contractor, National Government Services (NGS), urges all providers to update their addresses in the National Plan and Provider Enumeration System (NPPES). The SMRC uses this source to mail additional development requests (ADRs) for medical records; an incorrect address can result in records being returned and, as a result, claims being denied.

NGSConnex and IVR Systems Not Available this Weekend

NGS also reports that, due to scheduled maintenance, NGSConnex and the Interactive Voice Response System (IVR) systems will not be available this weekend.

For further information, contact Patrick Conole at (518) 810-0661 or