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Check here for a status of EDI systems and a log of resolved EDI issues.

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


Home Health PDGM claims are suspending with reason code C727E incorrectly. Reason code C727E indicates the HIPPS code submitted showed as community/late; however, records indicate it should have been institutional/late.


The HIPPS code on Home Health Patient-Driven Groupings Model (PDGM) claims are being recoded incorrectly.


Home health claims with dates of services on or after January 1, 2020, claims are going to the return to provider (RTP) file with reason code 37253 (no OASIS found). Currently, research does not indicate that there is a systems issue. Please refer to the Provider Action below.


For some hospice adjustments the end of life (EOL) Service Intensity Add-On (SIA) payment is not being made. This applies to some adjustments with dates of services prior to January 1, 2020, that were received on or after January 1, 2020.


CGS has identified two issues that affect some hospice claims with the type of bill (TOB) 8XC.

1. The Common Working File (CWF) has provided a work around when a provider is trying to transfer on 61st/91st day.
2. CWF is researching 8XC TOB when the previous provider's claim was billed with a Patient Status 50.


If you have submitted an Appeal to CGS, the Interactive Voice Response (IVR) system is not acknowledging that it was received.


Updated Description: The U5181 edit issue is for monthly billing in which a hospice's provider liability (OSC 77) ends for a late Notice of Election (NOE). The hospice is accepting liability for the late NOE and is not requesting an exception. Edit U5181 edit is firing assuming it is for a late recertification, which it is not.


This issue is a result of the recent hospice redesign as explained in SE18007 and is causing hospice claims with older dates of service that are being adjusted to go to the Return to Provider (RTP) file (T B9997) with reason codes U5150 and U5151 indicating issues with the hospice master record.


CGS has identified an issue affecting (XX7 type of bill) and cancellations (XX8 Type of bill) that are submitted via Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE), which are returning with reason code 30918. When entering these adjustments and cancellations thru DDE, the incorrect Medicare Beneficiary Identifier (MBI) is being applied.

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