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Claim Processing Issues LogClaims Processing Issues Log

Listed below are current system-related claims processing issues. Issues are shown by date reported with the most recently reported issue listed first. This log is updated frequently, as soon as information becomes available. CGS encourages 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 Description of Issue
09.11.2018 Some Medicare Secondary Payer (MSP) home health and hospice claims are being overpaid, as FISS is not subtracting the primary payer payment from the Medicare reimbursement.
08.16.2018 CGS has identified an ongoing issue with the two tier (high/low) payment rates for Routine Home Care services.
07.19.2018 System issues resulted in the recent redesigned hospice election/revocation improvements implemented with the July 2018 system release as explained in SE18007. See the Updates section below for details.
05.24.2018 The Fiscal Intermediary Standard System (FISS) has identified an issue with some Medicare Secondary Payment (MSP) claims.
05.08.2018 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.
03.29.2018 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.
06.14.2018 – Closed 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.
06.05.2018 –Closed 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.

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