J15 Part A Claims Processing Issues Log
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
J15 Part A Issues
|Provider Types Affected
||Impact to Providers
|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.
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.
CGS is awaiting further reprocessing instructions
from the CMS at this time.
|J15 Skilled Nursing Facilities (SNFs) and Swing Bed
||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.
A fix for this issue will be implemented on 12/05/2011.
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.