Listed below are current system-related claims processing issues that have been reported to the Centers for Medicare & Medicaid Services (CMS) and/or the Fiscal Intermediary Standard System (FISS) Maintainer. This information is updated as we receive new information or updates to share. Please check this Web page for updates before calling the Provider Contact Center, and watch for Listserv messages announcing updates to this page.
|Provider Types Affected
|Home Health and Hospice
||2/21/2017 – Some home health and hospice claims are suspending with reason code E94G2 in status/location S M90PP. FISS is incorrectly applying the reject reason code 32352 and changing the type of bill from 329 to 320.
||2/21/2017 – Home health and hospice claims affected by this issue are suspending in status/location S M90PP with reason code E94G2.
||2/21/2017 – (Updated 03/28/2017) The CGS Technical team is researching this issue. CGS Claims staff are manually working the claims to continue processing. Please note, according to the Medicare Claims Processing Manual (Pub. 100-04, Ch. 1, §184.108.40.206) Medicare contractors have 30 days to process clean claims. In the event that claims cannot be processed within 30 days, claims will be paid with interest.
||32403 and 32404
||1/20/2017 – Home health claims that span 2016 and 2017 dates of service, with line item dates of service prior to 1/1/2017 with HCPCS code G0163 or G0164 are incorrectly receiving reason code 32403. HCPCS G0163 and G0164 were retired and are no longer valid for services on or after 1/1/2017; however, they are valid for line item service dates prior to 1/1/2017.
||1/20/2017 – Home health claims affected by this issue appear in status/location S MFEE4 or in the Return to Provider (RTP) file, T B9997 with reason code 32403.
||1/20/2017 – This issue has been reported to the FISS maintainer.
||2/1/2017 – This issue has been resolved. Claims suspended in status/location S MFEE4, S MFEES, and S MHCPC will be released to cycle through FISS to continue processing. If you have claims in the Return to Provider (RTP) file related to this issue, press F9 to release the claim to continue processing.
||12/15/2016 – When a hospice claim for pneumococcal pneumonia and influenza vaccine is processed, the monthly claim including hospice services is incorrectly going to the Return to Provider (RTP) file with reason code U5601 indicating the dates of service overlap a previously processed claim.
||12/15/2016 – The hospice monthly claim billed with hospice services goes to the RTP file with reason code U5601.
||12/15/2016 – The Centers for Medicare and Medicaid Services (CMS) and the Common Working File (CWF) are aware of this issue.
If your monthly hospice claim is in RTP with reason code U5601 because your vaccination claim has processed, you may cancel (XX8) the vaccination claim. Once canceled, you may F9 the monthly hospice claim from the RTP file to continue processing.
CGS recommends hospices hold their vaccination claims at this time. However, after the monthly hospice claim processes, you may resubmit the vaccine claim and they will be held in status/location SMFLUH until this issue is resolved.
|2/14/2017 – This issue has been resolved. Providers may submit any flu claims that they may be holding.
5/6/16 – An issue has been identified with the 60 day 'high' and 'low' Routine Home Care rate being applied incorrectly.
5/6/16 – Some hospice claims with dates of service on and after January 1, 2016, are having the high RHC rate applied when the low rate should have been applied, and vice versa.
|09/28/16 – In the August 18, 2016, Provider eNews CMS notified hospices that Medicare Administrative Contractors (MACs) would adjust claims to correct miscounting of routine home care days. Due to incorrect payments, MACs will stop adjustments until a solution is implemented.
09/16/16 – Refer to the following articles for additional information:
5/6/16 – The Centers for Medicare & Medicaid Services (CMS) is aware of, and is researching this issue.
||E0419, V8029, V8030, V8031, and E46#V
||1/17/2017 – Some home health claims and adjustments are cycling in FISS with reason codes E0419, V8029, V8030, and V8031.
03/02/16 – The issue involving some adjustments (type of bill XXG), continues as previously reported. Refer to the "Resolved Fiscal Intermediary Standard System (FISS) Issues" web page for details.
|03/02/16 – Some home health claims and adjustments (type of bill XXG) are suspending in status/location S M90H4 with reason code E0419, V8029, V8030, and V8031.
||12/01/16 – A resolution to this issue has been scheduled for implementation in April 2017. Claims and adjustments affected by this issue will suspend in status/location S M90H4 with reason code E0419, V8029, V8030, and V8031.
5/6/16 – The April 25, 2016 system implementation failed to fully resolve this issue. The system maintainer has been informed. As mentioned below, CGS will continue to manually work through the suspended adjustments.
3/2/16 – A resolution to this issue is scheduled for implementation on April 25, 2016. Until a resolution is implemented, CGS will manually work through the suspended adjustments. Please note that due to the manual process and other limitations, some may not process until the scheduled implementation.