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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


As a result of additional research, it has been determined that there is a continuing overpayment issue that occurs with hospice adjustments. The resolution implemented on January 20, 2020, did not correct this issue.


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.


CGS is aware of delays in answering questions that have been submitted to the mail box. Our resources have been focused on getting payments made and we are now working through the questions that have been submitted. It may take a few days to work through all the questions but you will get a response as quickly as possible.


The HIPPS code on Home Health Patient-Driven Groupings Model (PDGM) claims are being recoded incorrectly.


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.


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


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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