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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 |
02.10.2023 |
E & M Codes 99221-99223, 99231-99236, 99238-99239 denied for place of service code 19 or 22 in error for 2023 dates of service. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Pending |
Part B |
OH – denial message CO5
KY – Denial message CO58 |
99221-99223
99231-99233
99238-99239 |
02/10/2023 |
Updates |
|
MAC Action |
Updates made to allow these codes in place of service 19 or 22. Within the next 2 to 3 weeks, a mass adjustment will be initiated for the claims that were denied in error. |
Provider Action |
No action required. |
Proposed Resolution |
We will adjust the claims that were denied in error. |
|
01.10.2023 |
Tracers A9500 and A9502 billed for more than 1 unit when being billed with a stress test that includes multiple session/studies are being split into 2 lines to allow 1 unit of the tracer and denying the additional units. The stress test we have seen billed has been 78452 whici is for multiple studies/sessions and the tracer would be given for all studies/sessions. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Part B Providers |
|
A9500, A9502 |
|
Updates |
|
MAC Action |
|
Provider Action |
|
Proposed Resolution |
We will adjust claims that have been denied for this isue. At this time it is expected the adjustment process will start by the end of this week. |
|
09.12.2022 |
Claims submitted with an Investigational Device Exemption (IDE) number. Claims processed from September 1st through September 12th may have denied in error when the IDE number was submitted on the claim. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Resolved |
Part B Providers |
MA50 |
Procedures that require an IDE number. |
09.12.2022 |
Updates |
|
MAC Action |
We will do a mass adjustment for claims denied in error. |
Provider Action |
No action required. |
Proposed Resolution |
System issue resolved. We will do a mass adjustment. |
|
08.16.2022 |
CMS identified a national system issue, which may have inadvertently adjusted previously processed Part B claims with dates of service (DOS) on or after January 1, 2021. These adjustments processed on July 29 through August 2, 2022 |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Part B Providers |
NA |
Impacted codes included the following: 99202-99205, 99211-99215, 99324-99328, 99334-99337, 99341-99345, 99347-99350, 99354-99355, 99495-99498, G0402, G0438, G0439, 99415, 99416. |
|
Updates |
|
MAC Action |
Claims for providers participating in the Primary Care First model are being reprocessed in some instances due to an error with a CMS Change Request for the Fee-For-Service claims processing system, which resulted in an incorrect payment. The reprocessing will ensure the provider receives the correct payment of a Flat Visit Fee rather than the Fee-For-Service fee for appropriate claims. |
Provider Action |
Most of the claims that inadvertently adjusted did not result in a change in payment; therefore, most providers were not impacted and no actions are required. If the adjustment caused a payment change or denial and you disagree with the decision, please submit an appeal. |
Proposed Resolution |
|
|
07.22.2022 |
Attention RSNAT myCGS Portal Users: Although PTAN information is not required in the section "Certifying Physician Information" on the prior authorization form to submit your RSNAT prior authorization request, we have found that to process requests through the portal you will need the PTAN information. This is temporary and CGS is aware of the issue. It will be resolved by 7/29. If you do not know the PTAN information you still can submit your requests via fax or mail. |