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J15 Part A Claims Processing Issues Log

Updated: 06.21.17

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
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 advice. 06.19.17
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.
Influenza and Pneumococcal Vaccines not Pricing Certain influenza and pneumococcal vaccine codes are not pricing on claims even though the vaccine administration is paying. 06.19.2017
If you have adjusted influenza or pneumococcal vaccines and they are still not pricing, contact the Part A Provider Contact Center at 1.866.590.6703 and advise them.

The issue has been resolved. Providers may adjust claims for reimbursement for influenza and pneumococcal vaccines that were previously not paid.

This issue is being researched and a ticket has been submitted to the FISS maintainer. Once the issue is resolved providers can adjust their claims to have the vaccines reimbursed.
Reason Code 32352 Certain claims were RTP'd in error, stating the type of bill is invalid for the HCPCS code. 06.19.2017
CGS has determined that there were additional HCPCS codes editing or RTPing with reason code 32352 in error. A large portion of those have been corrected. These claims will need to be F9'd or resubmitted. If the claims do not process after you have F9'd or resubmitted, contact the PCC and advise them of the HCPCS code and provide an example.

The file maintenance issue has been corrected. Providers may F9 or resubmit any claims in RTP status with reason code 32352 and they should process correctly.

There are additional claims for multiple HCPCS that are in RTP status due to a file maintenance issue. Providers will be notified once the corrections have been implemented.

This issue with HCPCS code J3489 billed on outpatient claims prior to January 1, 2017 and RTP'd in error has been resolved.

If there are claims with this HCPCS on an outpatient claim (13X type of bill) prior to January 1, 2017 that have not been released, providers may F9 the claim, or resubmit, and claims should process correctly.

CGS is working with FISS and will notify providers once the issue is resolved.

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