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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. 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
08.23.2018 System is denying service as not medically necessary as a result of an error with the ICD-10 code
08.16.2018 – closed Some providers are not able to view any Greenmail letters in the myCGS portal. Links for their letters display, but providers are unable to view.
07.20.2018 – closed A limited number of claims are failing a system audit regarding the patient's name being a mismatch to the patient's identifier.
07.19.2018 – closed Part B Medical Review letters submitted to Part B providers with wrong denial message. The issue impacted about 30 providers that had reviews completed for Evaluation and Management codes in June 2018.
07.02.2018 – closed myCGS portal Greenmail letters have not been delivered

06.20.2018 – closed

 

A system edit has been turned off that was rejecting and denying claims for certain electrocardiographic services.
02.27.2018 – closed The provisions affecting outpatient therapy services expired 12/31/2017. The new provision required the continued submission of HCPCS modifier KX for services in excess of the prior therapy cap amount for claims with dates of service on and after January 1, 2018. Due to a systems issue, services billed with HCPCS modifier KX in excess of the prior therapy cap amount were denied.

CR 10531 also affects payment of 2018 services rendered by Ambulance suppliers.

Additional, MPFS claims for localities and States impacted by the Work GPCI Floor fee increase for Dates of Service in CY 2018.
07.05.2018 – closed The Ohio Part B batch for July 2, 2018, failed resulting in no Medicare payment being issued today.
05.30.2018 – closed CPT codes 0449T and 0450T were to be end dated on a Category III CPT code edit. TOS F (Ambulatory Surgical Center) and TOS 8 (assistant-at-surgery) were mistakenly left as active.

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