Cahaba Government Benefit Administrators®,LLC is experiencing a high volume of providers who are opting out of the Interactive Voice Response (IVR) system to speak to a Customer Service Representative (CSR) for information that can be accessed through the IVR.
The Centers for Medicare and Medicaid Services (CMS) Internet Only Manual (IOM) Chapter 6 Section 50.1 states:
“Providers shall be required to use IVRs to access claim status and beneficiary eligibility information. CSRs shall refer providers back to the IVR if they have questions about claims status or eligibility that can be handled by the IVR. CSRs may provide claims status and/or eligibility information if it is clear that the provider cannot access the information through the IVR because the IVR is not functioning.”
If you are requesting whether Cahaba has received a claim or if a claim has finalized, this is considered a claim status request.
In addition, according to IOM Chapter 6 Section 80.3.4, “If a CSR or written inquiry correspondent receives an inquiry about information that can be found on a Remittance Advice (RA), the CSR/correspondent should take the opportunity to educate the inquirer on how to read the RA, in an effort to encourage the use of self-service. The CSR/correspondent should advise the inquirer that the RA is needed in order to answer any questions for which answers are available on the RA. Providers should also be advised that any billing staff or representatives that make inquiries on his/her behalf will need a copy of the RA.”
Cahaba CSRs have visibility as to the path the provider takes in the IVR and/or whether they opt out to speak with a representative up front. The CSR will instruct the provider to call back and utilize the IVR if they did not attempt to use this self service option as required by CMS.
Page last updated: March 23, 2010