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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. Click on the description to view details and check back often for updates that we post when they become available.
Closed issues remain on the active log for approximately 60 days before they move to the resolved issues archive list at the bottom of the page.
If you still have questions, please contact Customer Service or use one of our self-service tools.
| Date Reported |
Description of Issue |
04.27.2026 |
The two percent sequestration reduction is being applied twice on recently processed claims, beginning in mid-April for Part A and HHH claims. The deducted amount is reported under value code 73, and the corresponding remittance advice indicates CARC OA 121. |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Part A and HHH |
|
|
|
MAC Action |
This issue is currently being researched. 4/30/2026: The issue affecting certain claim payments has been resolved. A system fix was installed on 4/28/26. CGS will automatically adjust any claims that were underpaid because of this issue. No provider action is needed. CGS will provide updates as they become available. |
Provider Action |
No provider action is required. CGS will provide updates as they become available. |
Proposed Resolution |
|
|
| 04.17.2026 |
Reason Code W2054: Inpatient claims that meet the length of stay (LOS) requirement for reporting mechanical ventilation returned to provider (RTP'd) in error. |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
TOB 11X |
W2054 |
ICD-10-PCS 5A195ZZ; LOS > 5 days |
|
| MAC Action |
CGS will suspend claims until the system is corrected. |
| Provider Action |
No provider action. |
| Proposed Resolution |
FISS will correct the LOS input to the Medicare Code Editor (MCE). |
|
| 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: 04.30.2026