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J15 Part A Claims Processing Issues Log

Updated: 01.19.17

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 as we have new information or updates to share, 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
32352 Certain claims were RTP’d in error, stating the type of bill is invalid for the HCPCS code. 01.19.2017
CGS is working with FISS and will notify providers once the issue is resolved.
34943 Some ESRD claims (72X type of bill) were RTP’d in error due to an issue with the system edit. 01.19.2017
This issue has been addressed. However, if you identify additional claims in RTP status with reason code 34943, F9 or resubmit the claims for correct processing.
CGS has determined that there are claims that have RTP'd in error with reason code U6833/U6832.

This reason code states that "Medicare is billed as secondary payer due to a non-GHP; however, there is no matching diagnosis(es) on the claim and the non-GHP record(s) on CWF."
CGS is submitting Electronic Correspondence Referral System (ECRS) requests to the Benefits Coordination & Recovery Contractor (BCRC) on these claims. Providers can expect 30 days for normal claims processing time. Remarks on the claim will indicate that an ECRS has been submitted.
W7099/SM7099 13X type of bill claims were erroneously receiving reason code W7099 in one statutory exception.

Section 1861(s)(2)(I) of the Act provides Medicare coverage of blood clotting factors for hemophilia patients competent to use such factorsto control bleeding without medical supervision, and items related to the administration of such factors.
These issues have been resolved.

Claims receiving this reason code in error are being suspended until the January 2017 Integrated Outpatient Code Editor (IOCE) is implemented.

If there are claims that are RTP'd in error, F9 and resubmit, and claims will be suspended until the correction is implemented.

NOTE: There was an additional issue with W7099 editing incorrectly on non-OPPS claims. CMS and FISS have provided a work around for this issue. If you have claims RTP'd in error, F9 those claims for the work around to be applied.

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