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Claims 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.
Date Reported |
Description of Issue |
05.06.2022
– Closed |
HCPCS code J2326 denied when billed with place of service code 19 (Off Campus-Outpatient Hospital) |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Resolved |
Part B Providers |
NA |
HCPCS code J2326 |
05.11.2022 |
Updates |
|
MAC Action |
The allowed place of service codes were updated. |
Provider Action |
Please resubmit claims denied incorrectly. |
Proposed Resolution |
System update |
|
05.03.2022 |
Some COVID codes were set up incorrectly. Claims were denied in error for referring physician, or the physician was not eligible to bill the service. Also, some claims applied deductible and co-insurance incorrectly. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Resolved |
Physicians, Lab |
NA |
CPT codes 86408, 86409, 86413, 87426, 87811 and 0226U |
05.06.2022 |
Updates |
|
MAC Action |
The codes were updated. |
Provider Action |
None. |
Proposed Resolution |
A mass adjustment will be done for the claims that were processed incorrectly. |
|
03.16.2022 |
Some claims for drug codes received during the first week of February paid at 100% in error, instead of applying the 20% co-insurance. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Pending |
Part B |
NA |
Drug Codes |
NA |
Updates |
|
MAC Action |
The MCS Maintainer will identify the claims impacted and a list to CGS. |
Provider Action |
No action is required at this time. |
Proposed Resolution |
Claims will be adjusted through the mass adjustment process. |
|
01.13.2022
– Closed |
The claims containing these two COVID codes were incorrectly routed to Medical Review for review. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Closed |
Part B Providers |
NA |
0034A and 0071A |
01.18.2022 |
Updates |
|
MAC Action |
Will remove additional documentation requests and allow the claims to process. |
Provider Action |
No action is required of you. |
Proposed Resolution |
|
|
11.30.2021 |
Incorrect payment of claims billed with nine line items that include clinical lab codes. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Pending |
Part B Providers |
NA |
Clinical lab services |
|
Updates |
|
MAC Action |
Services paid incorrectly will be adjusted. |
Provider Action |
No action is required of you. |
Proposed Resolution |
Mass adjustment |
|
11.18.2021 |
Some drug claims processed between 10/26/21 and 10/29/21 were overpaid. These claims were processed with a 2% coinsurance amount instead of 20%. This was an MCS error. The problem was resolved. We are waiting for MCS to provide a list of claims that need to be adjusted. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Pending |
Part B Providers |
NA |
Drug Codes |
|
Updates |
|
MAC Action |
Adjust claims paid incorrectly |
Provider Action |
None at this time |
Proposed Resolution |
|
|
10.13.2021
– Closed |
Claims for CPT Code 0004A, for dates for service prior to 10/08/2021, were denied for Medicare Advantage (MA) Plan in error |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Pending |
Part B Providers |
109 |
CPT Code 0004A, Covid-19 Vaccine Administration – Booster |
11.17.2021 |
Updates |
|
MAC Action |
A mass adjustment will be done |
Provider Action |
No provider action is necessary. |
Proposed Resolution |
Correct the system; mass adjust claims |
|
07.15.2021 |
Part B claims may deny for prior authorization. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Part B |
284 |
Part B Claims |
|
Updates |
|
MAC Action |
|
Provider Action |
No provider action is necessary. |
Proposed Resolution |
After the fix is installed, we will adjust the claims that were previously denied. |
|