LICENSES AND NOTICES

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA websiteExternal Website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association websiteExternal Website.
  3. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
  4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
  5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.


Corporate


Print | Bookmark | Email | Font Size: + |

FISS Chapter 1

Chapter 1 – Overview

What is FISS?

The Fiscal Intermediary Standard System (FISS) is the standard Medicare Part A claims processing system. Through its Direct Data Entry (DDE) system you may perform the following functions:

  • Enter, correct, adjust, or cancel your Medicare billing transactions
  • Inquire about beneficiary eligibility
  • Inquire about the status of claims
  • Inquire about the need to respond to an additional development request (ADR)
  • Access various inquiry screens (e.g., revenue codes, diagnosis codes, reason codes, etc.)

FISS Availability

FISS is available Monday through Friday typically between the hours of 5:00 a.m. and 8:00 p.m. CT (Central Time) and Saturday between the hours of 5:00 a.m. and 5:00 p.m. CT. Note: Depending on the time it takes the nightly system cycle to run, FISS may not always be available at 5:00 a.m. CT. In addition, FISS system releases may affect availability over weekends. FISS is not available on Sunday or on national holidays.

Direct Access to FISS

If you want direct electronic access to FISS in order to perform the above functions, contact the CGS EDI (Electronic Data Interchange) department between 7:00 a.m. – 4:00 p.m. CT (8:00 a.m. 5:00 p.m. ET). For Home Health and Hospice providers, dial 1.877.299.4500 (select Option 2), or for Part A providers, dial 1.866.590.6703 (select Option 2) for assistance. You must also contract with a connectivity vendor to establish direct connection to the Enterprise Data Center (EDC) for FISS access through a connectivity product (e.g., IVANS or VisionShare). The CGS EDI department does not provide support for your connectivity product; therefore, you will need to contact your connectivity vendor for any issues related to your direct connection.

Back to the top of the page Top

Sign-on/Sign-off Procedures

Once connection has been established, the CGS EDI department will provide the necessary logon-ID and password. If you experience any security issues with accessing FISS or need to have your password reset, please email the CGS Security Administration Team at cgs.medicare.opid@cgsadmin.com or you may call them at 1.615.660.5444. Please include the user ID that is experiencing problems and the first and last name of the user to which that ID is assigned in your email request.

Back to the top of the page Top

CMS DXC Virtual Data Center

To access FISS DDE, type 2 in the Enter Request field on the DXC Virtual Data Center screen and press the ENTER key. The DXC–VDC Menu screen will display.

Screenshot

Back to the top of the page Top

DXC-VDC Sign-on Menu

  1. Type your logon-ID in the Userid: field.
  2. Tab to the Password: field and type your password.
  3. Press the ENTER key.

    Screenshot

    The TPX MENU FOR <logon-id> screen will display. Your cursor will be positioned in the Command ===> field in the lower left corner.

    Screenshot
  4. Use your Tab key to move your cursor to the left of the MAC J15 FISS PROD – HHH application line (for Part A providers HHH is replaced with PART A). Type an S and Press the ENTER key.

    The Welcome to CMS screen will appear as shown below. The cursor will be positioned in the upper left corner of the screen. type FSS0 (the 0 is the number zero; not the letter 'O') to access the FISS Main Menu.

    Screenshot

    Your connection through the Enterprise Data Center (EDC) may allow you to access the beneficiary eligibility information via the Common Working File (CWF) Part A Eligibility System screens, ELGA (Part A eligibility information) and ELGH (Home Health/Hospice eligibility information). To check beneficiary eligibility information via CWF records, instead of typing FSS0, type ELGA to access ELGA, or type ELGH to access ELGH. Press ENTER.

    When accessing ELGA or ELGH, you will be prompted to enter beneficiary information. Refer to the Checking Beneficiary Eligibility in this User Manual for additional information.

    Beginning fall of 2019, CMS discontinued clearinghouse and vendor access to the CWF beneficiary eligibility data when they already access this same data through the HIPAA Eligibility Transaction System (HETS). Providers can continue to submit individual provider queries using the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Beneficiary/CWF (Option 10). Refer to the Inquiry Menu in this User Manual for additional information.

Back to the top of the page Top

Terminating the Session

Follow the steps below when you are finished with FISS.

  1. When you are finished in FISS, press F4 to terminate your session. When you are finished in ELGA or ELGH press F3 to exit.
  2. Type logoff and press ENTER. The TPX MENU FOR <logon-id> screen will display.
  3. Your cursor will be positioned in the Command ===> field in the lower left corner. type /K and press the ENTER key.

Back to the top of the page Top

Accessing Multiple Sessions

With direct connection, you have the ability to access multiple sessions simultaneously. This means that you can be signed on to FISS and to ELGA or ELGH at the same time. To learn how to access more than one session, refer to the instructions provided by your connectivity vendor.

Back to the top of the page Top

FISS Menu Options

The FISS Main Menu contains four options (listed below). Additional instructions, screen illustrations and field descriptions of each option are included in this User Manual.

Screenshot

All the FISS functionality that you will need for claims processing is available through FISS options 01, 02, and 03.

The CWF Part A Eligibility System screens, ELGA (Part A eligibility information) and ELGH (Home Health/Hospice eligibility information) are accessible through the FISS connection; however, they are not accessible within the FISS menu options. Refer to the Checking Beneficiary Eligibility in this User Manual for additional information.

The following provides screen prints of the FISS DDE menu options 01 (Inquiry), 02, (Claim/Attachments), and 03 (Claims Correction) and a summary of how providers can utilize these menu options.

All FISS direct data entry (DDE) screens display two lines of information in the top right corner that identifies the region (ACPFA052), the current date, release number (e.g., C20112VF) and the time of day. This information will assist CGS staff in researching issues when screen prints are provided.

All FISS screens are referenced by Map numbers. Map numbers (e.g., MAP1701) are listed in the upper left corner of the screen. Each claim screen displays page numbers to the right of the Map number.

Back to the top of the page Top

Inquiry Menu

The Inquiry Menu allows you to check the status of claims, including how to check for Additional Development Requests (ADRs), claims summary, Medicare check history, payment totals, view inquiry screens to check the validity of diagnosis codes, revenue codes, HCPCS codes, and review reason code narratives.

The menu options shown in bold text are those that you will use most often. For additional details, refer to the Inquiry Menu section of this User Manual.


Screenshot

Back to the top of the page Top

Claim and Attachments Entry Menu

The Claim and Attachments Entry Menu allows you to enter UB-04 claim information, including home health requests for anticipated payment (RAPs), hospices notices of election (NOEs), notices of election termination/revocation (NOTRs) and roster bill data entry for influenza vaccines and pneumococcal vaccines provided by approved facilities. For additional details, refer to Claims and Attachments Menu section in this User Manual.

The "Attachment Entry" options are not accepted electronically via FISS DDE.

Screenshot

Back to the top of the page Top

Claims and Attachments Correction Menu

The Claims and Attachments Correction Menu allows you to correct billing transactions that are in the Return to Provider (RTP) file, adjust and cancel billing transactions.

The menu options shown in bold text are those that you will use most often. For additional details refer to the Claims Correction section in this User Manual.

The "Attachments" options are not accepted electronically via FISS DDE.

Screenshot

Back to the top of the page Top

FISS Shortcuts

  • Use your arrow keys and/or Tab key to move between fields. Do not use your ENTER key or the space bar. Using the Tab key is preferred, as your arrow keys may not place your cursor in the correct field position.
  • If you attempt to type in an invalid field position, your keyboard will lock. To "unlock" your keyboard, try to press the ESC key or the left Ctrl key. The method used to unlock your keyboard depends on your keyboard set up. Once you have unlocked your keyboard, you must press the Tab key to move your cursor into a valid field position.
  • To move back one data field at a time, press and hold the SHIFT key and then press Tab.
  • To quickly move between claim pages, press your HOME key on your keyboard, which takes your cursor to the 'Page' field. Type the number of the page to which you want to move, and then press Enter. In FISS, the claim consists of six pages. However, two additional pages, page 7 and page 8, are available for claims in Additional Development Request (ADR) status/location S B6001.
  • While in a claim, use the SC (Screen Control) field located in the upper left corner (under the Page field) of the FISS screen as a shortcut to information within the Inquiry Menu. To access this field, press the HOME key and then the Tab key. To quickly move to one of the following options, type the option number (e.g., 13) in the 'SC' field and press Enter. Press F3 to return to the claim page. Refer to the following example.

    10 Beneficiary/CWF 16 Adjustment Reason Codes
    13 Revenue Codes 17 Reason Codes
    14 HCPC Codes 56 Claim Count Summary
    15 Diagnosis/Procedure Codes 68 ANSI Reason Codes

    Example: To move from the Claim Entry screen to the revenue code screen, type 13 in the SC field and press ENTER. The Revenue Code Table Inquiry screen appears.

    Screenshot

Back to the top of the page Top

FISS Function Keys

The use of the function keys described below allows you to move within the FISS screens. FISS displays what function keys are available for use on the bottom of each screen. Function keys are most often found across the top of your keyboard.

F1

Help

From a claims entry, inquiry, or correction screen, F1 provides a narrative description of a reason code that appears on a billing transaction (used most often in the return to provider (RTP) file).

F2

Line Item Detail Info

Enables user to access line item detail information for a particular revenue code line in FISS from page 02 of the claim.

F3

Screen Exit

Exits user to previous screens.

F4

System Exit

Terminates FISS session and returns user to blank screen where 'FSS0', 'ELGA', 'ELGH', or 'Logoff' can be entered.

F5

Scroll Back

Scrolls up (backward) through a list of revenue code page.

F6

Scroll Forward

Scrolls down (forward) through a list or revenue code page.

F7

Page Back

Moves user one FISS claim page back.

F8

Page Forward

Moves user one FISS claim page forward.

F9

Save

Saves/stores claim information. (Note: FISS will only save information when the information is complete and correct.)

F10

Scroll Left

Scrolls one page to the left. Only available on the following screens:

  • MAP171A, MAP171E, MAP171D, MAP 1719, MAP1772

Also retrieves claim data for an archived claim.

F11

Scroll Right

Scrolls one page to the right. Only available on the following screens:

  • MAP1712, MAP1713, MAP171A, MAP171E and MAP1771

Use caution before pressing F3 because it will take you back to the previous screen and could cause you to lose your work. For example, if you are entering a billing transaction into FISS and accidentally press F3, you will be returned to the Claim and Attachments Entry Menu and the information you were entering on the billing transaction will be lost.

You may need to contact your connectivity vendor for assistance in mapping your keyboard if your function keys do not achieve the same results as described above.

Back to the top of the page Top

FISS Shortcuts

  • Use your arrow keys and/or Tab key to move between fields. Do not use your ENTER key or the space bar. Using the Tab key is preferred, as your arrow keys may not place your cursor in the correct field position.
  • If you attempt to type in an invalid field position, your keyboard will lock.  To "unlock" your keyboard, try to press the ESC key or the left Ctrl key. The method used to unlock your keyboard depends on your keyboard set up. Once you have unlocked your keyboard, you must press the Tab key to move your cursor into a valid field position.
  • To move back one data field at a time, press and hold the SHIFT key and then press Tab.
  • To quickly move between claim pages, press your HOME key on your keyboard, which takes your cursor to the 'Page' field. Type the number of the page to which you want to move, and then press Enter. In FISS, the claim consists of six pages. However, two additional pages, page 7 and page 8, are available for claims in Additional Development Request (ADR) status/location S B6001.
  • While in a claim, use the SC (Screen Control) field located in the upper left corner (under the Page field) of the FISS screen as a shortcut to information within the Inquiry Menu. To access this field, press the HOME key and then the Tab key. To quickly move to one of the following options, type the option number (e.g., 13) in the 'SC' field and press Enter. Press F3 to return to the claim page. Refer to the following example.

    10 Beneficiary/CWF 16 Adjustment Reason Codes
    13 Revenue Codes 17 Reason Codes
    14 HCPC Codes 56 Claim Count Summary
    15 Diagnosis/Procedure Codes 68 ANSI Reason Codes

    Example: To move from the Claim Entry screen to the revenue code screen, type 13 in the SC field and press ENTER. The Revenue Code Table Inquiry screen appears.

    Screenshot

Back to the top of the page Top

FISS Screen Prints

To print a copy of an FISS screen, try one of the following options:

  • Select File from the Toolbar and click on Print from the dropdown box
  • Press ALT+PRINT SCREEN
  • Press SHIFT+PRINT SCREEN
  • Press ALT+L

If you are unable to print using the options above, try pressing the PRINT SCREEN key on your keyboard, which will make a copy of the screen; then open a word processing software document and paste the copied image into it. You should then be able to print the word processing document. If none of these options work, and you have consulted with your technical support department with no resolution, please contact your connectivity vendor.

Back to the top of the page Top

Monitoring Your Billing Transactions

CGS recommends that you use FISS to check your billing transactions at least once a week. Checking more often is encouraged. For some billing transactions, you may need to take additional action after you have submitted them. There are often provider deadlines associated with these additional actions. For example, when responding to an additional development request (ADR) (status/location S B6001), documentation must be received by CGS within 45 calendar.

Some claims may be returned to the provider (RTPd) due to missing, incorrect, or incomplete information. You will need to access your billing transactions in the Return to Provider (RTP) to make the necessary corrections. When a claim is corrected from the RTP file, it will receive a new receipt date.

To assist you with monitoring your billing transactions, CGS has developed the following checklist. When you sign on to FISS, you should:

  • Check option 56 (Claim Count Summary) within the "Inquiry Menu" to see a quick summary of billing transactions that are currently processing in FISS. Refer to the Inquiry Menu section of this User Manual for information about the Claim Count Summary screen.
  • Correct any billing transactions that are in your RTP file. Refer to Claims Correction" section of this User Manual for additional information.
  • Respond to any ADR. Refer to the Inquiry Menu section of this User Manual for information about accessing ADRs.

Back to the top of the page Top

About Status/Location Codes

As billing transactions process in FISS, they move through various stages of the system. These stages are identified by status/location codes and provide information about what's happening to the billing transaction. Sometimes the status/location indicates that you need to take action on the billing transaction in order for it to continue processing. There are six status codes that are represented in FISS by one letter (e.g., P for Paid). By looking at the status, you can quickly find what's happening to your billing transaction. Review the table below to familiarize yourself with these codes. This table will be a valuable resource when reviewing the Claim Count Summary (56) screen.

Claim Status Which Means?

P (Processed/Paid)

Claim is approved for payment and is on the payment floor. This is also considered to be a finalized status.

R (Rejected)

Billing transaction is rejected for reasons such as:

  • Medicare eligibility issue
  • Billing issues
  • Duplicate to a previously submitted claim

D (Denied)

Claim is denied by medical review or claim was submitted as a demand denial.

S (Suspended)

Billing transaction is temporarily paused in FISS for processing and/or Medicare staff intervention may be required. No action is required by you unless the claim is in status/location S B6001 (Additional Development Request (ADR)). Billing transactions may be suspended for about 30 days. Claims that have been selected for an ADR or for medical review may be suspended for more than 30 days. Claims with Medicare Secondary Payer (MSP) information often require Medicare staff intervention and may be suspended for more than 60 days.

T (Return to Provider [RTP])

Billing transaction is waiting for correction by you in the RTP file.

I (Inactivated)

Billing transaction was inactivated or suppressed from RTP. Awaiting final system purge.

Locations further define what is happening to a billing transaction in a particular status. Locations are 5-character positions that follow the status code (e.g., P B9997; where P is the status and B9997 is the location). There are thousands of combinations of status/locations and not all are represented in this guide. Because of the quantity, CGS does not provide a printed handout of all the possible status/location code combinations. However, we do provide you with the most common status/location codes listed below.

Back to the top of the page Top

Common Status/Location Codes

P B9996

Payment floor

P B9997

Processed or paid (full or partial) billing transaction

P B7501

Post-pay MSP review

P B7505

Post-pay MSP review

P O9998

Archived claim

R B9997

Rejected billing transaction (finalized)

R B75XX

Rejected billing transaction (suspended). It may take at least 75 days for the claim to move to R B9997 finalized status/location.

D B9997

Denied claim (all services denied).

Claims with partial denials will appear in the P status.

T B9900

Billing transaction will need correction when it moves into T B9997 in next cycle.

T B9997

Billing transaction needing correction by provider (referred to as the Return to Provider (RTP) status/location).

S B0100

System processing (billing transaction is suspended).

S B6000

Claim will need additional information when it moves to S B6001.

S B6001

Claim needs additional information from provider (often referred to as ADR, MR ADR (medical review Additional Development Request) or non-MR ADR).

S M50MR

Medical review of documentation (claims move to this location once ADR information has been received). This review process may take up to 60 days to complete.

S M5CLM

After the ADR documentation has been reviewed by the Medical Review department, the claim is moved to S M5CLM for additional processing.

S B90XX

Claim data is being compared with beneficiary eligibility information posted at the Common Working File (CWF).

S MXXXX

Suspended claim/adjustment requires Medicare staff intervention and may be suspended for about 30 days. Claims with Medicare Secondary Payer (MSP) information may be suspended for more than 60 days. Providers may call the Provider Contact Center if their claims have been in the same "S M XXXX " status/location for longer than 30 days, or 60 days for MSP claims.

S M87DR

Hospice Only – acknowledgement that CGS has received the documentation for an exception request for an untimely notice of election. Refer to the "Requesting an Exception for an Untimely NOE" Web page for additional information.

S M87RE

Hospice Only – the documentation provided in the Remarks field for an exception request for an untimely notice of election is being reviewed.

S M8877

Hospice Only – if documentation for an exception request for an untimely notice of election is not received within 30 days of the initial request, the claim will move to this status/location until day 45, or until your documentation is received. If documentation is not received by day 46, the claim will be released to process as billed. Refer to the "Requesting an Exception for an Untimely NOE" Web page for additional information.

S MRADJ

MSP adjustment – created after MSP adjustment received; awaiting completion.

I B9900

Billing transaction inactivated from RTP file; waiting to purge from FISS.

Back to the top of the page Top