J15 Part A Claims Processing Issues Log
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
|Reason Code C7251
||Claims are denying in error stating that services were within a Skilled Nursing Facility (SNF) stay when there is no SNF stay indicated on the Common Working File (CWF).
This issue has been resolved.
The CWF has responded that reason code C7251 is setting when a prior SNF claim has discharge status of 30 (still a patient) on the claim. The prior claim will need to be corrected to indicate the correct discharge status code before the claim receiving C7251 can process.
CGS is still actively working with the CWF to resolve the issue.
| Reason Code C7252
|| Claims are denying or being recouped in error because of incorrect editing at the CWF.
Mass adjustments were completed in July 2016.
CGS has implemented a correction for claims rejected incorrectly for reason code C7252 as of June 14, 2016. Claims rejected with C7252 in error prior to June 14, 2016 will be adjusted by CGS to pay correctly. Adjustments should be completed by mid-September.
CGS will create a work-around in FISS to override the C7252 response for lines containing revenue code 0510 and HCPCS G0463. CGS will also adjust claims denied in error.
CGS is aware of the issue and is communicating with the Fiscal Intermediary Standard System (FISS) maintainer and the CWF to resolve the issue.