Claims 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
10.17.2018 Certain claims are in RTP status with reason code 1A005 indicating that the middle initial of the beneficiary's name is incorrect.
10.11.2018 ESRD claims are claim level rejecting with Reason Code 36342 instead of line item rejecting. CGS is aware of the issue and affected claims will be adjusted appropriately, or providers may adjust rejected claims if needed.
10.10.2018 Electronic Claims rejecting on the Front End on the 277CA report for diagnosis codes effective 10/1/2018
10.05.2018 FY 2019 IPPS and LTCH PPS Claims Hold
10.05.2018 Claims with HCPCS Code Q5110 held until January 2019 quarterly I/OCE is implemented.
09.24.2018 Certain adjustments are RTPing in error with Reason Code EA002.
08.22.2018 A subset of Inpatient Psychiatric Facility (IPF) claims are cycling with reason code C7563.
07.25.2018 85X bill types suspended and workaround performed by CGS
06.11.2018 It has been brought to CGS' attention by CMS that Positron Emission Tomography (PET) claims containing certain radiopharmaceutical Healthcare Common Procedure Coding System (HCPCS) codes are returning to provider (RTP'ing) in error as of January 1, 2018, date of service (DOS).
05.22.2018 The Fiscal Intermediary Standard System (FISS) has identified an issue with some Medicare Secondary Payment (MSP) claims.
05.14.2018 Because of a known Fiscal Intermediary Standard System (FISS) issue, outpatient claims were recycling in the Common Working File (CWF) inappropriately. This issue was/is occurring because the allowed amounts associated with the Average Sales Price (ASP) drugs are not able to be included in with the EXP TO DED field.
04.09.2018 Providers are receiving denials stating that no MolDX Z-ID was listed on the claim or the MolDX Z-ID and HCPCS associated is a mismatch.
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.

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