||Incarcerated beneficiary claim denials
Please refer to the updated CMS Incarcerated Beneficiary FAQs for updated information: CMS FAQs
At this time, CGS has not received further official direction from CMS on this issue. Please refer to the CMS Incarcerated Beneficiary Claim Denial FAQs for information on common questions: CMS FAQs
Providers and suppliers should not resubmit claims. CMS is working diligently to develop a process to automate the reprocessing of the claims that were denied in error, and resubmitted claims complicate the solution.
As of 08.15.2013, claims will suspend to SMOSUK until we receive further instructions from CMS. We are also awaiting instructions for claims that denied prior to 08.15.2013.
||Medicare Secondary Payer (MSP) claims are processing incorrectly due to changes implemented in CMS Change Request (CR) 7605 on January 7, 2013.
Reminder: verify MSP records prior to submitting claims to ensure correct claim processing. Please refer to CMS MLN Matters article SE1205 for more information regarding issues with the COBC.
A workaround has been made available for U6825. CGS continues to research the other issues noted below.
Reason code U6802 has not been identified as an issue. Providers are encouraged to review and correct/resubmit these claims.
Reason code U6805 has been identified as an issue and is being researched.
Reason codes U6802 and U6805 are still being researched. Providers are encouraged to review claims that receive these edits and correct/resubmit claims that did not RTP in error.
CWF has determined that reason code U6826 is editing correctly. Reason codes U6802 and U6805 are still being researched.
Reason code U6826 is being researched by CWF. Reason codes U6802 and U6805 were previously listed but have been removed while we research to determine if these codes should also be reported.
Reason codes U6802 and U6826 are being researched by FISS. Reason code U6805 has been removed; however, CGS will research to determine if it should also be reported to FISS.
The issue is being researched by FISS.
The issue has been reported and is being researched by CMS and the Common Working File (CWF).
|39071, 39072, 39073
||Medicare Secondary Payer (MSP) claims are rejecting with reason code 39071, 39072, or 39073 when a non-trauma diagnosis code is included on a liability, no-fault, or Workers' Compensation record in the Common Working File (CWF).
Claims are suspending to SMOSUF until further direction is received.
The fix that went into production on 10.07.13 was unsuccessful and the issue is still being researched.
A fix is tentatively scheduled on 10.07.13.
CWF has determined that some claims are editing incorrectly. Claims will suspend to SMOSUH while the issue is being researched.
Resolved. After further research, we have determined that this was not a Part A system issue and claims that were suspended to SMOSUG have been released. However, some claims may have rejected in error. You may review any rejected claims to determine the following:
- If the claim contains a diagnosis code that matches a diagnosis listed on an open liability, no-fault, or Workers' Compensation (WC) record in CWF, the claim will reject.
- If the claim contains a diagnosis code that matches a diagnosis listed on an open liability, no-fault, or WC record in CWF, but the services provided on the claim were not related to the liability, no-fault, or WC incident, you may adjust the claim and report condition code D9 and the following statement in the Remarks section: Not related to open MSP record.
- If the claim contains a diagnosis code that matches a diagnosis listed on an open liability, no-fault, or WC record in CWF, but the diagnosis is a non-trauma diagnosis (e.g., diabetes, hypertension, etc.), you may contact the Part A PCC to have an Action Request submitted.
The tentatively scheduled fix is for home health and hospice claims only. CGS will research claims rejecting with these reason codes to determine if this should be reported to FISS for Part A.
A fix is tentatively scheduled on 10.07.2013.
Claims have been set to suspend to SMOSUG while the issue is researched.
You may contact the Part A PCC to have an Action Request submitted to determine if the diagnosis code(s) are related/unrelated to the MSP file. However, we are experiencing delays with the Action Requests due to a high volume of requests and a claim cycling issue that occurs after the MSP file is updated.