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J15 Part A Claims Processing Issues Log

Updated: 04.14.14

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
WW999 Claims for services paid under the Medicare Physician Fee Schedule (MPFS) for dates of service on or after April 1, 2014 04.04.2014
CMS has instructed contractors to suspend claims until April 14, 2014. Claims will be held in location SMFISS. Additional information is available in the CMS Provider Education Message published on March 28, 2014.
31795-31797, 31818, 34910, 39011, 39012, 39015 Certain A/B rebilling claims will RTP in error due to an issue with the April quarterly release. 04.04.2014
CMS has instructed contractors to suspend claims that receive these reason codes beginning April 7, 2014. Claims will be held in locations SMCLM1-SMCLM6 until a fix is successfully implemented into production. A fix is tentatively scheduled in late April 2014.
39910 An issue has been identified for claims that received reason code 39910 and meet the following criteria:
  • Type of Bill = 14X
  • Submitted by a Critical Access Hospital
  • Dates of service on or after April 1, 2013
04.04.2014
CMS has instructed contractors to suspend these claims beginning April 7, 2014. Claims will be held in location SMCLM7 until a fix is successfully implemented into production. A fix is tentatively scheduled in May 2014.
7OPPS Claims that meet the following criteria will RTP with reason code 7OPPS due to an issue with the OPPS Pricer Update:
  • 12X and 13X claims for HCPCS codes J1446 and J7178 for dates of service on and after January 1, 2014.
  • 12X and 13X claims for HCPCS code A9545 for dates of service on and after April 1, 2014.
04.04.2014
CMS has instructed contractors to suspend these claims. Claims will be held in location SMCLM9 until a fix is successfully implemented into production. A fix is tentatively scheduled in late April 2014.
31274-31277 Several diagnosis codes are included in both the ICD-9 and ICD-10 code files. Therefore, claims submitted with those ICD-9 codes are receiving reason codes 31276 and 31277 for ICD-10 editing. 04.11.2014
Resolved

04.04.2014
Claims held in location SMHICD for reason codes 31274-31277 have been released.

03.28.2014
Claims are currently suspending in location SMHICD. If you have claims that are in RTP status with reason codes 31274-31277, verify the diagnosis codes on the claim, then F9.
This issue has been reported to the FISS system maintainer and to CMS.

MSP Relationship MSP claims with a patient relationship of 18 are not populating on the Standard Paper Remittance (SPR) correctly. The primary insured name is indicated rather than the Medicare beneficiary that is covered under the spousal benefits. 04.11.2014
The correction for dates of service going forward is scheduled in May.
The correction for dates of service prior to the fix will be implemented in June.
03.28.2014
FISS has identified the issue and a correction is tentatively scheduled in May.
03.21.2014
CGS is aware of the issue and has reported the issue to FISS for further research.
U5450 U5454 Some outpatient therapy claims are receiving various RTPs/rejections incorrectly from the Common Working File (CWF) related to the functional therapy reporting requirements. 03.21.2014
Providers should still verify that they are billing according to the information published in SE1307, and the article posted on the CGS website, Functional Reporting for Outpatient Therapy Services: Reminders.
This problem was reported to CWF. CWF is working with the CMS on a resolution.
U6806, U6826 Certain MSP Claims are suspending incorrectly. 04.04.2014
Reason code U6806 is being researched.
03.21.2014
FISS has identified the issue for U6826, and a correction is tentatively scheduled in late April, 2014.
U538H Incarcerated beneficiary claim denials 04.04.2014
Claim adjustments are tentatively scheduled in April 2014.
02.13.2014
Providers that received refunds should have received a check and spreadsheet by the middle of December 2013. If providers feel they should have received a refund and did not, contact the Part A PCC to determine if a spreadsheet was sent and not received. If so, a duplicate spreadsheet will be sent within 48 hours.
To reconcile the RA, access the claims listed in the spreadsheet in DDE to obtain the individual claim amount. The total of the individual claims may not equal the total check amount on the spreadsheet since other offsets may have occurred. After research, if you cannot determine the claim information for the offsets or you have specific questions, you may contact the Part A PCC at the number listed above.
12.06.2013
Please refer to the updated CMS Incarcerated Beneficiary FAQs for updated information: CMS FAQs
11.22.2013
Please refer to the updated CMS Incarcerated Beneficiary FAQs for updated information: CMS FAQs
11.15.2013
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
08.30.2013
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.
08.23.2013
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.


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