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 |
---|---|---|---|---|---|---|---|---|---|
09/23/2024 |
All DME Suppliers |
258 |
N/A |
Claims with a receipt date of 07/14/2024–09/22/2024 may be denying for incarcerated status when the beneficiary does not have an incarcerated record(s) in the Common Working File (CWF). |
CGS will reprocess claims that denied in error with ANSI Remark Code 258: Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state, or local authority may cover the claim/service. |
No action needed. |
Claims denied in error will be adjusted once the CWF record has been corrected. |
In Progress |
TBD |
11/06/2023 |
Suppliers who submit claims to the DME MAC when the from date of service equals the date of discharge from home health services and the beneficiary is no longer a patient. |
97 |
Home Health Consolidated Billing for the following: Urological, Ostomy, Tracheostomy, Surgical Supplies. |
This issue affects claims with dates of service on and after 01/01/2022 in which the date of service equals the date of discharge from home health services and the beneficiary is no longer a patient. These claims may be denying incorrectly for a home health episode. |
Claims with incorrect denials will be adjusted when brought to the DME MACs attention via a redetermination request. |
If the denial is incorrect, submit a redetermination for correction. |
Editing will be corrected at the Common Working File, (CWF) to prevent the incorrect denials and recoupments. |
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. |
NA |
NA |
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. |
NA |
NA |