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Claim Payment Alerts
Please reference this page for information about confirmed, system-related issues before you reach out to Customer Service.
TIP: Click on a description to view more details. Check back for updates.
| Date Reported |
Description |
| 04.27.2026 |
The 2% sequestration reduction applied twice on processed claims beginning in mid-April. |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Part A and HHH |
N/A |
Value Code 73, CARC OA 21 |
|
| MAC Action |
06.03.2026 – Impacted claims suspended to status/location SM4215. CGS will initiate claim adjustments to correct the underpayment. |
| Provider Action |
No provider action. |
| Proposed Resolution |
This issue is in research.
04.30.2026 – A system fix was installed on 04.28.2026 to prevent additional claim payment errors.
06.03.2026 – FISS identified claims with underpayments. |
|
| 03.20.2026 |
Reason Codes 31006 & 31007: Some Method II Critical Access Hospital (CAH) claims for professional services returned to provider (RTP'd) indicating the physician/practitioner doesn't have a reassignment on file in PECOS. |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
TOB 85X |
31006, 31007 |
Dates of service on or after July 1, 2025; revenue codes 096X, 097X, or 098X |
|
| MAC Action |
- Temporarily turn off reason codes 31006 & 31007.
- Reprocess RTP claims on or after January 1, 2026.
|
| Provider Action |
Make sure your physicians and practitioners accurately reassign benefits to your facility. See Reason Codes 31006 & 31007: Professional Reassignment to Method II CAH Not Found for guidance. |
| Proposed Resolution |
Temporarily turn off reason codes 31006 & 31007 to give providers additional time to submit their reassignment applications. |
|
| 02.19.2026 |
Reason Codes 31006 & 31007: Some Critical Access Hospital (CAH) claims for CRNA pass-through exemption services returned to provider (RTP'd) in error. |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
TOB 85X |
31006, 31007 |
Receipt date on or after January 2, 2026; Revenue code 0964; Provider has a valid CRNA pass-through on file. |
|
| MAC Action |
CGS will apply a temporary workaround until the shared system is corrected. |
| Provider Action |
No provider action. Please see MM14417 for additional information. |
| Proposed Resolution |
Change Request (CR) 14417 implements the necessary system changes on October 5, 2026. |
|
| 07.29.2025 |
Reason Code W7113: Some claims returned to provider (RTP'd) in error |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Outpatient TOBs except 12X & 22X |
W7113 |
Supplementary or additional code not allowed as principal diagnosis code |
|
| MAC Action |
CGS will suspend claims to apply a workaround until the issue is resolved |
| Provider Action |
If you identify RTP claims, please F9 or resubmit for CGS to apply the workaround. |
| Proposed Resolution |
A system correction is planned for a future quarterly release. |
|
Updated: 06.30.2026
Reviewed: 06.30.2026