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Claim Payment Alerts
Please reference this page for information about confirmed, system-related 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 |
08.15.2024 |
Reason Code U538H: An Eligibility Database (EDB) update that incorrectly identifies some beneficiaries as incarcerated caused the Common Working File (CWF) to reject claims in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
HH&H providers |
U538H |
N/A |
|
MAC Action |
CGS will suspend claims to status/location (S/LOC) S MINCR until the issue is resolved. |
Provider Action |
|
Proposed Resolution |
CMS is researching to determine how to correct the incarceration date for impacted beneficiaries and process claims that rejected in error. |
|
07.29.2024 |
Reason Code 32073: A system outage at the Virtual Data Center (VDC) caused home health claims to return to the provider (RTP) in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Home Health |
32073 |
TOB 34X |
|
MAC Action |
CGS will suspend claims until a resolution is determined. |
Provider Action |
|
Proposed Resolution |
In research |
|
07.10.2024 |
Reason Code 17729: Some hospice claims denied in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Closed |
Hospice |
17729 |
Attending Physician NPI & Name |
08.20.2024 |
MAC Action |
08.20.2024: Claim adjustments to reprocess claims that received reason code 17729 in error are complete. Claims that correctly denied will deny with reason code 17729 again.
07.25.2024: CGS will reprocess claims that received the edit in error. |
Provider Action |
08.20.2024: Use the CMS Order and Referring Dataset to verify the physician record on file. If the physician believes the file is incorrect, the physician should follow the process to update his/her enrollment record in PECOS.
07.19.2024: No provider action is needed. Hospices should allow the MACs to adjust the claims to prevent any additional issues.
Hospices that have adjusted or started adjusting these claims may cause them to be missed in the MAC adjustments. Claims adjusted by the hospices will not be included in the MACs' adjustments. |
Proposed Resolution |
07.19.2024: Research identified errors (missing or incorrect physician records) in the Hospice PECOS Physician File used for this edit. A file correction was implemented on July 16, 2024, and claims received since should not deny with reason code 17729 in error.
Within 30 days of this update, Medicare Administrative Contractors (MACs) will reprocess claims with the following criteria:
- Rejected with reason code 17729
- Types of Bill 081x or 082x
- Claims with 'FROM' dates on or after 6/03/2024
Claims that correctly denied for 17729 should deny again. |
|
07.09.2024 |
July 2024 remits are currently unavailable. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Closed |
Home Health & Hospice |
N/A |
N/A |
07.17.2024 |
MAC Action |
|
Provider Action |
|
Proposed Resolution |
We are working quickly to restore them for you. |
|
07.03.2024 |
Reason Codes 326XX: One or more payer only codes may assign to a claim and cause it to return to provider (RTP) in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Home Health & Hospice |
326XX |
Payer only code(s) |
|
MAC Action |
CGS removed value code Z9 from RTP claims submitted prior to, or during the installation of, the July 2024 release on 7.1.2024. |
Provider Action |
Remove any payer only codes before you F9/resubmit RTP claims or submit an adjustment or cancel claim.
Refer to the CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 1, section 190 for a complete list of payer only codes. |
Proposed Resolution |
A system fix is scheduled with the April 2025 release. |
|
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 |
N/A |
Provider Action |
N/A |
Proposed Resolution |
08.22.2024 – CGS will adjust affected claims once we receive additional instructions.
04.29.2024 – CGS received additional claim examples after the system update was installed. We will continue to research and provide an update when available.
03.18.2024 – A system update was installed.
Currently in research. |
|
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.
Update: A system fix is scheduled for the January 2025 release. |
|
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. |
|