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


CGS is aware that Notices of Election (NOEs) are RTPing with reason code 32114 when the 9-digit ZIP code is not transmitted via EDI submission. NOEs submitted via DDE are currently processing correctly.


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


Hospice providers may notice that the information provided in the Interactive Voice Response (IVR) system and myCGS may not reflect all current hospice periods. Please refer to Change Request 11277 for additional information.


CGS has identified an ongoing issue with the two separate payment rates for hospice routine home care (RHC) services (high/low).


Updated Description: The U5181 edit issue is for monthly billing in which a hospice's provider liability (OSC 77) ends for a late Notice of Election (NOE). The hospice is accepting liability for the late NOE and is not requesting an exception. Edit U5181 edit is firing assuming it is for a late recertification, which it is not.


In some situations where providers are submitting claims under the Medicare Beneficiary Identifier (MBI), the claim processes under the beneficiary's Health Insurance Claim Number (HICN). This seems to occur when the Common Working File (CWF) shows that a new HICN is assigned to the beneficiary. New and subsequent claims are processing under the new HICN; when the prior claim information is under the old HICN and is not cross referencing to the new HICN. This is causing claims to go to the return to provider (RTP) file with reason code 38107 (matching home health RAP cannot be found) and 37402 (hospice sequential billing).


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.

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