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J15 Part A Claims Processing Issues Log

Updated: 03.04.15

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

36602, 36381 Status Locations SMG279 and SMG280

HCPCS codes G0279 and G0280 are not pricing when submitted on claims.

Claims with HCPCS codes G0279 or G0280 will be suspended in location SMG279 and SMG280 until the FISS April Quarterly Release, scheduled to go into production on 04.06.15, is implemented.  There is no workaround.  Once the release is implemented, suspended claims will be released 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.

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.

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