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Claims Processing Issues Log
Please reference this page for information about confirmed, system-related claims processing issues before you reach out to the Provider Contact Center. Click on the description to view details and check back often for updates that we post when they become available.
Closed issues remain on the active log for approximately 60 days before they move to the resolved issues archive list at the bottom of the page.
If you still have questions please contact the Provider Contact Center or use one of our self-service tools.
Date Reported |
Description |
02.14.2024 |
Reason Code U523A: Some hospice claims rejected in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Hospice |
U523A |
|
|
MAC Action |
|
Provider Action |
|
Proposed Resolution |
Currently in research. |
|
01.17.2024 |
Reason Code 31175: Beginning on 01.02.2024, home health claims RTP'd in error because the values loaded in the iQIES system did not populate in FISS. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Home Health |
31175 |
EMC submissions with TOB 329 |
|
MAC Action |
02.15.2024 – CGS released claims held in S/LOC SM1033 and will monitor to ensure they continue to process.
Claims will suspend to status/location (S/LOC) SM1033 until we receive a resolution and/or further instructions. |
Provider Action |
N/A |
Proposed Resolution |
02.12.2024 – A system update was installed.
A system update is scheduled on 02.12.2024. |
|
08.01.2023 |
Reason Code 19963: Some home health claims returned to provider (RTP'd) in error because the corresponding NOA is offline. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Home Health |
19963 |
NOA in Status/Location (S/LOC) O B9997 |
|
MAC Action |
02.22.2024 –CGS was not able to restore/process all affected NOAs/claims. See Provider Action update below.
10.06.2023 – CGS will restore the affected NOAs and process the associated claims within 45 calendar days.
08.23.2023 – A system update will not allow additional NOAs to move offline. |
Provider Action |
02.22.2024 – If you identify NOAs/claims that CGS was not able to restore/process per the MAC Action on 10.06.2023, please fax your list of claims to 615-660-5982.
Review claims that RTP with RC 19963. If a claim doesn't meet the criteria above, correct and resubmit it. |
Proposed Resolution |
See MAC Action and Provider Action. |
|
01.11.2023 |
Reason Code 31755: Some home health claims returned to provider (RTP'd) in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Home Health |
31755 |
See Provider Action. |
|
MAC Action |
|
Provider Action |
As of January 3, 2023, home health claims should RTP when the revenue code 0023 line-item date of service doesn't match the date of the first home health visit.
- For initial and subsequent periods of care, report the date of the first covered visit provided during the period on the revenue code 0023 line.
- For subsequent periods, do not report the first day of the period. Report the first visit date whether it was covered or non-covered.
Reference Chapter 10 – Home Health Agency Billing.
If applicable, correct the date(s) of service and resubmit the claim.
If you identify a claim that meets the following criteria, call the Provider Contact Center (PCC). Once validated, the PCC will submit a request for Claims to bypass the edit.
- December 2021 billing period start dates that span to 2022
- January 2022 billing period start dates that used the artificial admit date
|
Proposed Resolution |
See Provider Action. |
|