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Check here for a status of EDI systems and a log of resolved EDI issues.

Claims Processing Issues Log

Listed below are current system-related claims processing issues. Updates are made to this log frequently, as soon as information becomes available. We encourage 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 Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

01.16.18

Open

Providers who submit therapy services

CMS is instructing contractors to hold claims for dates of service in 2018, submitted for therapy services and containing HCPCS modifier KX, until further notice.

N/A

Therapy services

 
Updates

01.30.2018 - Starting January 25, 2018, CMS will immediately release for processing held therapy claims with HCPCS modifier KX with dates of receipt beginning from January 1-10, 2018. Then, starting January 31, 2018, CMS will release for processing the held claims one day at a time based on the date the claim was received, i.e., on a first-in, first-out basis. At the same time, CMS will hold all newly received therapy claims with HCPCS modifier KX and implement a "rolling hold" of 20 days of claims to help minimize the number of claims requiring reprocessing and minimize the impact on beneficiaries if legislation regarding therapy caps is enacted. For example, on January 31, 2018, CMS will hold all therapy claims with HCPCS modifier KX received that day and release for processing the held claims received on January 11, 2018. Similarly, on February 1, 2018, CMS will hold all therapy claims with HCPCS modifier KX received that day and release for processing the held claims received on January 12, and so on.

Under current law, CMS may not pay electronic claims sooner than 14 calendar days (29 days for paper claims) after the date of receipt, but generally pays clean claims within 30 days of receipt

MAC Action
Provider Action

N/A

Proposed Resolution

Waiting for additional direction from CMS


Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

01.25.2018

Closed

All providers

The Interactive Voice Response (IVR) system is not calculating the QMB deductible and coinsurance amounts correctly.

NA

NA

02/12/2018

Updates

02.14.2018 – This issue has been resolved.

MAC Action

01.25.2018 – CGS is working to resolve this issue.

Provider Action

02.14.2018 – Providers can now use the IVR (1.866.290.4036) to obtain a breakdown of the deductible and coinsurance amounts.
01.25.2018 – At this time, please contact the Part B Provider Contact Center (PCC) at 1.866.276.9558 for assistance in getting a breakdown of the deductible and coinsurance amounts.

Proposed Resolution  

Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved
01.16.18 Open Providers who submit therapy services CMS is instructing contractors to hold claims for dates of service in 2018, submitted for therapy services and containing the KX modifier, until further notice. N/A Therapy Services  
Updates
MAC Action  
Provider Action N/A
Proposed Resolution Waiting for additional direction from CMS

Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

01.24.18

Closed

Primarily Independent Clinical Labs

Effective for claims with line item dates of service on and after January 1, 2018, contractors shall not bundle or roll up individually billed lab test HCPCS code to a lab panel HCPCS code or an ATP code. 

N/A

G0058, G0060, 80048, 80053, 80069, 82040, 82248, 82251, 82330, 82435, 82550, 82947, 83615, 84100, 84155, 84450, 84478, 84550, G0059, 80047, 80051, 80061, 80076, 82247, 82250, 82310, 82374, 82465, 82565, 82977,84075, 84132, 84295, 84460, 84520, 80072, 83718, 85651, 86430, 86694, 86709, 86777, 87340, 80049, 80074

01.25.18

Updates

CGS has identified some of the system settings to turn off lab panel HCPCS were not set correctly. CGS has corrected the settings.

MAC Action

System updates were corrected and CGS will adjust the impacted claims.

Provider Action

N/A

Proposed Resolution

System issues were corrected.


Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved

01.01.18

Closed

Part B Providers/ Suppliers

Claims held due to the January 2018 release

N/A

All 2018 dates of service

01.17.18

Updates

N/A

MAC Action

All claims released 01.17.18

Provider Action

N/A

Proposed Resolution

N/A


Date Reported Status Provider Type Impacted Description of Issue Reason Codes Claim Coding Impact Date Resolved
11.15.2017 Closed All providers Payers secondary to Medicare aren't able to process some of your direct billed claims due to patient responsibility deductible and coinsurance amounts on the Medicare Remittance Advice (RA) showing zero. Claims automatically crossed over from Medicare to secondary payers aren't impacted. N/A N/A  
Updates  
MAC Action N/A
Provider Action Providers may want to hold QMB claims and submit them after December 8. Reference the CMS QMB Remittance Advice Issue announcement for additional information.
Proposed Resolution On December 8, 2017, CMS systems will revert back to the previous display of patient responsibility for QMBs on the Medicare RA.

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