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Claim Payment Alerts
Please reference this page for information about confirmed, system-related issues before you reach out to Customer Service.
TIP: Click on a description to view more details. Check back for updates.
| Date Reported |
Description |
06.12.2026 |
Reason Codes U5565 & U5566: Admission date doesn't match the election period start date. Claims after a hospice transfer returned to provider (original claims) or rejected (claim adjustments) in error. |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Hospice |
U5565 & U5566 |
TOBs 813, 814, 823, 824; admission date |
|
MAC Action |
CGS will provide an update when available. 07.07.2026 – CGS temporarily turned off the reason codes until the edit correction is implemented. |
Provider Action |
Please check back for instructions. 07.07.2026 – F9 or resubmit RTP (reason code U5565) claims for processing. If a claim adjustment (TOB 8X7) rejected (reason code U5566), submit a new claim adjustment. |
Proposed Resolution |
Change Request (CR) 14427 implemented these edits for all hospice claims with dates of service on or after April 1, 2026. An edit correction to bypass claims after a transfer will be implemented with a future quarterly release. |
|
04.27.2026 |
The 2% sequestration reduction applied twice on processed claims beginning in mid-April. |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Part A & HHH |
N/A |
Value Code 73, CARC OA 21 |
|
MAC Action |
06.03.2026 – Impacted claims suspended to status/location SM4215. CGS will initiate claim adjustments to correct the underpayment. |
Provider Action |
No provider action is required. CGS will provide updates as they become available. |
Proposed Resolution |
This issue is in research.
04.30.2026 – A system fix was installed on 04.28.2026 to prevent additional claim payment errors.
06.03.2026 – FISS identified claims with underpayments. |
|
07.29.2025 |
Reason Code W7113: Some home health claims returned to provider (RTP'd) in error. |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
TOB 32X or 34X |
W7113 |
Supplementary or additional code not allowed as principal diagnosis |
|
MAC Action |
CGS will suspend claims to apply a workaround until the issue is resolved. |
Provider Action |
If you identify RTP claims, please F9 or resubmit for CGS to apply the workaround. |
Proposed Resolution |
A system correction is planned for a future quarterly release. |
|
07.10.2025 |
Reason Code 70AD1: CGS recently detected a significant number of incorrectly billed hospice claims. Claims have been submitted for continuous care using the admission date as the “From” date of service on the claim, instead of the beneficiary's start of care date. |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Hospice providers |
70AD1 |
TOB 8X3 or 8X4; admission date = "From" date of service |
|
MAC Action |
|
Provider Action |
Please review the "Attention: Hospice Billing Reminders & a New Claim Edit" article. |
Proposed Resolution |
|
|
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 |
3.27.2025 – Some HH claims with admission dates prior to August 23, 2023, and "Through" dates within approximately 18 to 24 months of the admission date continue to edit for 19963 in error.
This issue should not impact HH claims with admission dates after August 23, 2023, or claims with "Through" dates more than 24 months from the admission date.
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 |
3.27.2025 – Continue to monitor RTP claims. If a claim RTP'd in error before January 6, 2025, F9 or resubmit for processing. If the edit is correct, see the instructions below.
01.06.2025 – Continue to monitor RTP claims and correct the NOA and/or claim when:
- There's no NOA on file for the admission.
- The NOA RTP'd or rejected.
- The HHA cancelled and never resubmitted the NOA.
- The claim admission date and NOA "From" date don't match.
- Another claim with earlier service date(s) closed the admission.
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.
Update: A system fix is scheduled for the January 2025 release.
01.06.2025 – CR13684 ensures home health claims submitted more than 24 months after the admission date don't RTP in error when the associated NOA is offline. |
|
Updated: 07.07.2026
Reviewed: 07.07.2026