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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
10.24.2018 – closed Based on CR 10494, mass adjustments were done to correct the remittances for Qualified Medicare Beneficiary (QMB) claims that were processed between 10/2/17 and 12/31/17. There is a small volume of therapy claims that paid originally but were denied in error on the adjustment.
10.29.2018 All claims for MolDx procedures were required to include the MolDx ID. There was a recent change to this policy that excludes the professional component (CPT mod 26)
10.24.2018 An audit that denies CPT codes with a 'ZZZ' global period when the primary code is not billed was inadvertently disabled from September 6 - October 24, 2018. Codes that should have denied were paid in error.
10.10.2018 Electronic Claims rejecting on the Front End on the 277CA report for diagnosis codes effective 10/1/2018
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.

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