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

Claim Processing Issues LogClaims 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
07.21.2020

Payment for hospice routine home care (RCH) services are calculating incorrectly when there is a transfer involved.

07.09.2020

Reason Code 37578 is causing claims submitted via Direct Data Entry (DDE) to go to the Return to Provider (RTP) file incorrectly.

07.08.2020

Home health claims submitted as part of the Maryland Total Cost of Care Model were denied incorrectly.

04.17.2020

When an 8XB NOTR is billed and the through date is past the current open benefit period on the Common Working File, the NOTR will open the next benefit period. This is working as expected. However, when the final hospice claim is submitted it is being sent to the Return To Provider (RTP) with reason code U5165.

09.27.2019

CGS has identified two issues that affect some hospice claims with the type of bill (TOB) 8XC.

1. The Common Working File (CWF) has provided a work around when a provider is trying to transfer on 61st/91st day.
2. CWF is researching 8XC TOB when the previous provider's claim was billed with a Patient Status 50.

06.11.2019

If you have submitted an Appeal to CGS, the Interactive Voice Response (IVR) system is not acknowledging that it was received.

01.04.2019

This issue is a result of the recent hospice redesign as explained in SE18007 and is causing hospice claims with older dates of service that are being adjusted to go to the Return to Provider (RTP) file (T B9997) with reason codes U5150 and U5151 indicating issues with the hospice master record.

07.10.2020 - Closed

CGS has identified an issue causing some home health and hospice claims to receive reason codes 31138 and W7218 inappropriately.

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