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J15 Part A Claims Processing Issues Log

Updated: 10.24.11

Here is a list of current system-related claims processing issues. These issues have been reported to CMS and/or the Fiscal Intermediary Standard System (FISS). Please check here often for updates before contacting the Provider Contact Center. If you still have questions, please Contact Us.

J15 Part A Issues

Provider Types Affected Situation Impact to Providers Status
J15 Rural Health Clinics (RHCs)  The Centers for Medicare & Medicaid Services (CMS) has instructed CGS to hold all rural health clinic claims (type of bill 71x) containing preventative services noted in Change Request 7208.   Claims impacted by this issue will be held in a suspense location until a correction is implemented.  

10/21/2011
This issue has been reported to the Fiscal Intermediary Shared System (FISS) maintainer and a fix is being scheduled. Please continue to check the log for information regarding a scheduled date for the fix.

J15 Part A The July 2011 system release incorrectly affected Medically Unlikely Edits (MUEs) for several HCPCS/CPT codes. Claims submitted with HCPCS/CPT codes affected by this issue are denying incorrectly with reason code 51MUE or 52MUE.

10/21/2011
CGS is awaiting further reprocessing instructions from the CMS at this time.

J15 Skilled Nursing Facilities (SNFs) and Swing Bed (SB) Change Request (CR) 7019, effective January 1, 2011, instructs providers to report the ARD date with occurrence code 50. However, the Health Insurance Prospective Payment System (HIPPS) code AAA00 does not need an accompanying occurrence code 50.  SNF and swing bed claims billed with the default HIPPS code AAA00 (no-pay bills) are editing incorrectly with reason code 31742 and cannot continue to process. 10/21/2011
A fix for this issue will be implemented on 12/05/2011.

09/15/2011
This issue has been reported to the FISS maintainer and a fix is being scheduled. Please continue to check the log for information regarding a scheduled date for the fix.


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