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.

Most Recent Update Description of Issue
11.20.2019 The Centers for Medicare & Medicaid Services (CMS) has identified an issue with obtaining current MSP information via the HIPAA Eligibility Transaction System (HETS). This affects MSP information available in myCGS, and the interactive voice response (IVR) system.
11.25.2019 CMS has identified an issue related to the implementation of the Patient Driven Payment Model (PDPM).
11.25.2019 Critical Access Hospital (CAH) Swing Bed claims are receiving a Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) edit (reason code 31864) in error.
10.15.2019 It has come to the attention of the Centers for Medicare & Medicaid Services (CMS) that the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) edit 7275 is denying Part B ambulance claims inappropriately. This is occurring when the beneficiary is in a covered Part A SNF stay but requires a Part B covered transport for emergency services and when the transport claim is billed with Healthcare Common Procedure Coding System (HCPCS) code A0427, A0429, or A0433.
10.15.2019 CGS has been notified by CWF that beneficiary eligibility dates may be missing from the CWF beneficiary files. They have received many examples and will be looking into the issue. This will affect eligibility inquiries using the myCGS portal, Interactive Voice Response (IVR) system and the CWF eligibility systems, ELGA/ELGH.
10.17.2019 The Centers for Medicare & Medicare Services (CMS) has identified an error in the 2019 Inpatient Facility Prospective Payment System (IPF PPS) currently in production. The Fiscal Year (FY) 2019 IPF PPS Pricer applicable to dates of service on or after October 1, 2018, contains approximately 18 valid Medicare Severity Diagnosis Related Group (MS-DRGs) that are returned to provider (RTP) in error, after receiving an invalid return code '54' from the IPF PPS Pricer.
10.17.2019 The Centers for Medicare & Medicare Services (CMS) is aware of an issue causing the Medicare Beneficiary Identifier (MBI) on the incoming claim to link to an inactive Health Insurance Claim Number (HICN). This is impacting a limited number of claims.
10.17.2019 CGS is aware of certain issues with Medicare Advantage claims.

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