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J15 Part A Claims Processing Issues Log

Updated: 01.16.15

Listed below are current system-related claims processing issues that have been reported to the Centers for Medicare & Medicaid Services (CMS) and/or the Fiscal Intermediary Standard System (FISS) Maintainer. This information is made available and updated on a weekly basis so you may review prior to contacting the Part A Provider Contact Center. A list of resolved issues is also available at the end of this list. If you still have questions, please call 866.590.6703.

Reason Code/Status Location Situation Status

55503, 54500

Some Mammography claims were submitted with covered ICD-9 codes, in accordance with our Local Coverage Determination (LCD), but were denied incorrectly.

The number of claims identified that were denied in error was small. These claims will be manually adjusted by CGS.

37096 (IRF PAI)

Some IRF claims are receiving reason code 37096, even though the PAI has been submitted timely to QIES.

CGS is in the process of researching the issue.

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