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Claim Processing Issues LogClaims Processing Issues Log

Listed below are current system-related claims processing issues. Updates are made to this log frequently, as soon as information becomes available. We encourage you to review this log often and prior to contacting the Provider Contact Center. A list of resolved issues is also available at the end of this list. If you still have questions, please contact the Provider Contact Center or use one of our self-service tools.

Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

06.14.2018

Open

Home Health and Hospice

Providers are unable to correct claims and home health Requests for Anticipated Payments (RAPs) that are in the return to provider (RTP) file with reason code U6803. In addition, home health providers are unable to enter RAPs for beneficiaries that have an open MSP record.

U6803

NA

 
Updates

 

MAC Action

06.14.2018 – The correction for this issue is scheduled for implementation on July 2, 2018.

Provider Action

06.14.2018 – Once the July 2, 2018 fix is implemented, providers will be able to submit RAPs and correct claims that are in RTP with reason code U6803.

Proposed Resolution

06.14.2018 – The correction for this issue is scheduled for implementation on July 2, 2018.


Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

06.05.2018

Open

Home Health providers

Medicare Secondary Payer (MSP) home health final claims and LUPA claims are being overpaid. Claims received after April 2, 2018 and paid after April 27, 2018 are paying without consideration of the primary payment and OTAF amounts.

NA

NA

 
Updates  
MAC Action
Provider Action

06.05.2018 – No action necessary by providers.

Proposed Resolution

06.05.2018 – A resolution to this issue is scheduled for implementation on August 20, 2018.


Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

05.24.2018

Open

HH&H Providers

The Fiscal Intermediary Standard System (FISS) has identified an issue with some Medicare Secondary Payment (MSP) claims.

U6803, U6816, U6817, U6818, U6819, U681D, U681E, U681L, 39074, E61#H

Suspend in Location SM0628

 
Updates  
MAC Action

05.24.2018 – MSP claims hitting an identified reason code (Reason Codes) will be suspended and not Returned to Provider (RTP). The correction for this issue will be installed into production on July 2, 2018, and suspended claims will be released.

Provider Action

NA

Proposed Resolution  

Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

05.22.2018

Open

Home Health and Hospice

Claims submitted for processing with a Medicare Beneficiary Identifier (MBI) that were returned for valid reasons currently cannot be corrected through the Fiscal Intermediary Shared System (FISS) Direct Data Entry (DDE) system. The issue will be resolved no later than Tuesday, July 3, 2018.

NA

NA

 
Updates  
MAC Action

 

Provider Action

05.22.2018- To avoid delays in payment, submit a new claim to CGS if an MBI claim was returned to you.

Proposed Resolution  

Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

05.08.2018

Open

Home Health and Hospice

Claims are being submitted with the new Medicare Beneficiary Identifier (MBI) and the Fiscal Intermediary Standard System (FISS) is attaching an invalid Health Insurance Claim Number (HICN) to the claim, causing the claim to go to the Return to Provider (RTP) file for various reasons.

Various reason codes (e.g., 38107 or 37402)

MBI

 
Updates

05.17.2018 – The Centers for Medicare & Medicaid Services (CMS) has provided instructions to suspend home health and hospice claims submitted with an MBI that receive reason codes 38119, 38107, or 37402 until an update is installed.  The update is currently scheduled for July 2, 2018.  The affected claims will be suspended in status/location S MPMBI.

05.08.2018 – This issue has been reported to the FISS maintainer for additional research.

MAC Action

05.17.2018 – After the update, which is currently scheduled for July 2, 2018, is implemented, CGS will release the claims to continue processing.

05.08.2018 – None at this time.

Provider Action

05.08.2018 – Providers may suppress the claim showing in the Return to Provider (RTP) file with the invalid HICN and resubmit the claim using the beneficiary's correct HICN.

Proposed Resolution  

Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

05.07.2018

Closed

Home Health and Hospice

Claims that were originally submitted for processing with a Health Insurance Claim Number (HICN) as the beneficiary identifier are being incorrectly displayed in Direct Data Entry (DDE) with the Medicare Beneficiary Identifier (MBI). Claims should be displaying in DDE with the original identifier submitted on the claim (either the HICN or MBI).

NA

HICN/MBI

06.04.2018
Updates

06.06.2018 – A resolution to this issue was implemented on June 4, 2018. 

05.07.2018 – If you use the MBI returned through this display error on claims, the beneficiary will receive a Medicare Summary Notice with the MBI on it, possibly before they receive their new Medicare card containing their MBI. This issue will be resolved no later than May 29, 2018.

For More Information:

MAC Action

No action at this time.

Provider Action

05.07.2018 – To avoid confusion, please do not use a beneficiary's MBI until one of these occur:

  • They present their new Medicare card (which will contain their MBI)
  • The MBI is available through your Medicare Administrative Contractor's secure portal
  • Their MBI is shared through the remittance advice starting in October 2018
Proposed Resolution

05.07.2018 – This issue will be resolved no later than May 29, 2018.

Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

03.29.2018

Open

Home Health and Hospice

The Fiscal Intermediary Standard System (FISS) rejected Non-Group Health Plan (GHP) (No-Fault, Worker's Comp, and Liability) claims processed on or after October 3, 2016, incorrectly.

34133, 34134, 34137, 34138, 34139, 34140, 34141, 34142, 34143, 34144, 34145, 34146, 34147, 34148, 34149, 34152, 34153, 34154, 34299, 34300, 34304, 34379, 34381, 34383, 34507, 34508, 34512, 34544, 34545 or 34549

No-Fault, Worker's Comp, and Liability

 
Updates

05.07.2018 – No update at this time.

04.23.2018 – CGS has been notified that the CMS instructions are being delayed until further notice.

03.30.2018 – FISS will install a fix on April 23, 2018 and claims rejected incorrectly shall be adjusted.

MAC Action

03.30.2018 – The Centers for Medicare & Medicaid Services (CMS) has provided instructions for CGS to mass adjust claims rejected with the above listed reason codes once the fix has been installed. In addition, any Home Health Request for Anticipated Payment (RAP) processed on or after October 3, 2016 through April 23, 2018 (date fix will be installed) with reject code equal to U6816, U6817 or U6818 along with reason codes 34XXX (listed above) shall be cancelled.

Provider Action

03.30.2018 – Home Health providers will be advised when to resubmit the RAPs that were cancelled.

Proposed Resolution

03.30.2018 – FISS will install a fix on April 23, 2018.


Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

02.20.2018

Open

Home Health and Hospice

The MAS (Medicare Appeals System), used to effectuate favorable and partially favorable Appeals, is not working appropriately to allow some claims to process and pay.

NA

Appeal Redeterminations

 
Updates

05.31.2018 –No further update at this time.  The MAS contractor is monitoring to report anything if any effectuations are missed.  At this time no permanent fix has been implemented as expected.

04.23.2018 – The CMS MAS contractor has identified all the effectuations involved in this issue. A permanent correction is scheduled for implementation in May. Until then, a report will be run so that all effectuations are identified and are processed as appropriate.

04.09.2018 – No update at this time.

03.21.2018 – No update at this time.

03.07.2018 – No update at this time. CGS continues to work with the CMS MAS contractor.

MAC Action

04.23.2018 – See the "Updates" information above.

02.20.2018 – This issue has been reported to the Centers for Medicare & Medicaid Services (CMS) MAS contractor.

Provider Action

04.23.2018 – No action is required.

02.20.2018 – Update: CGS is unable to identify the claims affected by this issue. Therefore, if you have received a partially or fully favorable appeal decision outside of 60 days, and have not yet received payment, please contact the CGS Provider Contact Center at 1.877.299.4500, Option 1.

Proposed Resolution

04.23.2018 – A correction is scheduled for implementation in May.


Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

10.30.2017

Open

Home Health

The reason code 37253 cannot be bypassed for claims that are submitted with the 'DR' condition code (CC) indicating a waiver under §1135 of the Social Security Act.

37253

DR Condition Code

 
Updates

03.07.2018 – No updates available until the CR 10372 is implemented on July 2, 2018.

02.09.2018 – No additional update at this time.

02.01.2018 – CMS issued MM10372External PDF "Ensuring Correct Processing of Home Health Disaster Related Claims and Claims for Denial" with information about creating a bypass with condition code DR is reported on the claim.

01.09.2018 – CMS released Change Request 10372 "Ensuring Correct Processing of Home Health Disaster Related Claims and Claims for Denial" on January 5, 2018, with an implementation date of July 2, 2018.

12.11.2017 – CMS is working to issue a Change Request to resolve this issue.

11.27.2017 – No additional update at this time.

11.13.2017 – No additional update at this time.

10.30.2017 – The Centers for Medicare & Medicaid Services (CMS) has provided instructions to suspend home health claims after validating CC 'DR'. Periodically when a number of suspended HH claims build up, or not less frequently than weekly if any HH claims are suspended, the reason code 37253 will be temporarily deactivated. The suspended claims with CC 'DR' will be released for processing, and then the reason code will be reactivated.

MAC Action

10.30.2017 – This process will continue for as long as claims for dates of service subject to the waiver are timely or until the reason code can be revised.

Provider Action

10.30.2017 – None

Proposed Resolution

01.09.2018 – CMS released Change Request 10372 "Ensuring Correct Processing of Home Health Disaster Related Claims and Claims for Denial" on January 5, 2018, with an implementation date of July 2, 2018.

10.30.2017 – CMS will add a bypass for CC 'DR' to reason code 37253 in a future Change Request, so this workaround will not be needed in the case of future emergencies.


Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

03.02.2016

Closed

Home Health

01.17.2017 (Home Health) – Some home health claims and adjustments are cycling in FISS in status/location S M90H4 with reason codes E0419, V8029, V8030, and V8031.

03.02.2016 – The issue involving some adjustments (type of bill XXG), continues as previously reported. Refer to the "Resolved Fiscal Intermediary Standard System (FISS) Issues" web page for details.

E0419, V8029, V8030, V8031, and E46#V

NA

05.07.2018
Updates

05.07.2018 – After monitoring the above reason codes, claims and adjustments are processing normally.

03.22.2018 – The issue with reason codes V8029, V8030, V8031, have been resolved. At this time, 50 claims remain suspended with reason code E0419. The Claims department continues to work to process these claims. If you have questions, contact the Provider Contact Center at 1.877.299.4500.

02.06.2018 – A resolution related to reason codes V8030 and V8032 has been scheduled for implementation on March 5, 2018.

02.01.2018 – The CGS Claims department continues to work with the Technical staff. No additional update at this time.

01.09.2018 – No additional update at this time.

12.11.2017 – Although a resolution was implemented on November 6, 2017, claims continue to suspend. Additional research is being done.

11.27.2017 – A resolution was implemented on November 6, 2017 to correct reason code V8031.

11.13.2017 – No additional update at this time.

10.30.2017 – No additional update at this time.

08.01.2017 – Although the July 3, 2017 system release did allow some claims to process from the status/location S M90H1, an additional resolution is needed. At this time, the additional resolution has not been scheduled for release. Please note that CGS continues to explore manual workarounds to allow these claims to process.

05.30.2017 (Updated 06.09.2017) – At this time, adjustments (TOB XXG) continue to suspend in status/location S M90H4 and S M90H1. Additional issues related to the value codes were discovered. FISS maintainers have scheduled a resolution for implementation on July 3, 2017. Please note that this resolution does not address final claims.

12.01.2016 – A resolution to this issue has been scheduled for implementation in April 2017. Claims and adjustments affected by this issue will suspend in status/location S M90H4 with reason code E0419, V8029, V8030, and V8031.

05.06.2016 – The April 25, 2016 system implementation failed to fully resolve this issue. The system maintainer has been informed. As mentioned below, CGS will continue to manually work through the suspended adjustments.

03.02.2016 – A resolution to this issue is scheduled for implementation on April 25, 2016. Until a resolution is implemented, CGS will manually work through the suspended adjustments. Please note that due to the manual process and other limitations, some may not process until the scheduled implementation.

MAC Action

NA

Provider Action

03.22.2018 – No provider action is required.

Proposed Resolution

NA


Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

10.11.2017

Closed

Home Health

Type of bill 3XG PEP adjustments caused a negative amount in Value Code 17 which caused overpayments to display on the Summary page of the remittance advice in the Adjustment to Balance Field.

NA

NA

05.21.2018
Updates

05.21.2018 –The April 23, 2018 fix was successful.  Since this issue caused overpayments, the CGS will initiate the overpayment recovery process.

05.07.2018 – The April 23, 2018, fix was implemented; however, CGS is researching to ensure the fix was successful.

04.05.2018 – It appears the fix was reassigned and is now scheduled for implementation on April 23, 2018.

03.07.2018 – The March 5, 2018, fix was implemented; however, CGS is researching to ensure the fix was successful. 

01.09.2018 – A resolution to this issue is scheduled for implementation on March 5, 2018.

12.11.2017 – The resolution was implemented on November 20, 2017. However, after checking a sample, it was found the issue was still happening. This has been reported to the Fiscal Intermediary Standard System (FISS) maintainer.

11.27.2017 – No additional update at this time.

11.13.2017 – A resolution to prevent this from happening is scheduled for implementation on November 20, 2017. Providers are unable to correct this issue by adjusting the claim

MAC Action

05.21.2018 –CGS will initiate the overpayment recovery process.

11.13.2017 – No action at this time.

Provider Action

11.13.2017 – Do not adjust the claim in an attempt to fix this issue. Further instructions will be forthcoming.

Proposed Resolution

01.09.2018 – A resolution to this issue is scheduled for implementation on March 5, 2018.

11.13.2017 – A resolution to prevent this from happening is scheduled for implementation on November 20, 2017.


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