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J15 Part A Claims Processing Issues Log

Updated: 09.08.17

Listed below are current system-related claims processing issues that have been reported to the Centers for Medicare & Medicaid Services (CMS) and/or the Fiscal Intermediary Standard System (FISS) Maintainer. This information is made available and updated as we have new information or updates to share, so you may review prior to contacting the Part A Provider Contact Center. A list of resolved issues is also available at the end of this list. If you still have questions, please call 866.590.6703.

Reason Code/Status Location Situation Status
55503 – Claim Level, 53139 – Line Level Claims submitted with HCPCS code J9217 (Leuprolide Acetate (for depot suspension) 7.5 mg, LCD Number: L34093) and covered diagnosis code C61 were denied in error. 09.08.2017
CGS will correct the edit and adjust claims denied in error. Estimated completion date is October 1, 2017.
55503 – Claim Level
53101, 53105, 53107 - Line Level
CGS has identified an issue with reason codes 53101, 53105, and 53107 denying at the claim level with reason code with reason code 55503 instead of at the line level with the appropriate line level reason code. 08.25.2017
Mass adjustment of these claims denied in error will be completed. These adjustments will address claims that have been denied and claims that are pending appeal decisions. 
32402, 32403, or 32404 Some claims are being RTP'd in error with these reason codes. If you have determined that the service has been billed correctly, contact the Part A PCC and advise. 06.19.2017
CGS is aware that some claims are RTP'd in error and is researching and updating the appropriate files.
32227 Some claims are being RTP'd in error stating that a revenue code is present with no rate.  06.19.2017
CGS is aware of the issue and is currently researching. Providers will be advised once the issue is resolved.

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