Claim Payment Alerts
| Date Reported | Provider Type Impacted | Reason Codes | Claim Coding Impact | Description of the Issue | Action Required by the MAC | Action Required by the Provider | Proposed Resolution/Fix | Status | Date Resolved |
|---|---|---|---|---|---|---|---|---|---|
| 10/05/2026 | Suppliers who submit claims for Oral Anti-Cancer Drug Capecitabine (Xeloda). | 151 | N/A | Claims with a receipt date of 10/01/2026 - 10/13/2026, for the Oral Anti-Cancer Drug Capecitabine (Xeloda) may have been incorrectly denied due to exceeding the allowable number of services. | CGS will reprocess claims billed as Capecitabine (Xeloda) with ANSI Reason Code CO-151, ANSI Remark Code MA01. | No action required. | Claims that have been processed incorrectly will be adjusted. Information regarding claim adjudication and payment will be included in a future remittance advice. |
In Progress | TBD |
| 02/01/2019 | Suppliers of HCPCS codes E1020, E1028, E2368, E2369, E2370, E2375, K0015 and K0070 | 96 | E1007, E1020, E1028, E2228, E2368, E2369, E2370, E2375, K0015 and K0070 | Claims for HCPCS codes E1020, E1028, E2228, E2368, E2369, E2370, E2375, K0015 and K0070 may have denied incorrectly due to a system processing issue. NOTE: This is an ongoing issue with no ETA for resolution. | The issue causing the claim processing error cannot be corrected at this time. | No action required. | A report will be run monthly and claims will be adjusted if the denial was incorrect. | N/A | N/A |
| 02/01/2019 | Suppliers of wheelchair accessories. | 151 | Wheelchair accessory HCPCS codes. | Claims for wheelchair accessories may have denied as same or similar equipment incorrectly due to a system processing issue. NOTE: This is an ongoing issue with no ETA for resolution. | The issue causing the claim processing error cannot be corrected at this time. | No action required. | A report is run monthly, and claims are adjusted if the accessories were denied incorrectly. | N/A | N/A |
Updated: 10.21.2026

