CorporateBusiness Services

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

Claims Processing Issues Log

Listed below are current system-related claims processing issues. Updates are made to this log frequently, as soon as information becomes available. We encourage 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

Status

Provider Type Impacted

Description of Issue

Reason Codes

Claim Coding Impact

Date Resolved

08.21.2017

Closed

Home Health

Home health no-payment claims submitted with condition code 21 are being denied in error with an incorrect reason code (37253 - no OASIS assessment found). No payment claims do not require an OASIS assessment.

37523

Condition Code 21

09.26.2017

Updates

09.26.2017 – Research revealed that no-payment claims submitted with a 329 type of bill (TOB) will generate an incorrect denial reason code.  No-payment claims must be submitted with TOB 320 and condition code 21.  For details on submitting no-payment claims, refer to the CGS Home Health No-Payment Billing (Condition Code 21) Web page.

08.21.2017 – The Fiscal Intermediary Standard System (FISS) and the Centers for Medicare & Medicaid Services (CMS) are aware of this issue and are currently working on a resolution.

MAC Action

NA

Provider Action

Bill no-payment claims with the appropriate Type of Bill 320 and condtion code 21 to prevent an incorrect denial.

Proposed Resolution

NA


Date Reported

Status

Provider Type Impacted

Description of Issue

Reason Codes

Claim Coding Impact

Date Resolved

08.21.2017

Pending

Home Health and Hospice

Home health and hospice claims and Requests for Anticipated Payment (RAPs) are being rejected in error.

U6815, U6816, U6817, U6818

NA

 

Updates

10.09.2017 – See the MAC Action and Provider Action sections below.
09.22.2017 – In addition to claims being rejected in error, Requests for Anticipated Payment (RAPs) were also being rejected in error with reason codes U6815, U6816, U6817, or U6818. CMS has provided instructions for CGS to cancel all the RAPs that were rejected in error between 6/5/17 through 8/7/17.

Once the RAPs have cancelled, CGS will notify providers to resubmit the RAPS.

In addition, within 45 days after the 11/6/17 system release, CGS will initiate claim adjustments that were rejected in error during this time period.

08.21.2017 – The Fiscal Intermediary Standard System (FISS) is aware of this issue and are currently working on a resolution.

MAC Action

10.09.2017 – CGS has initiated cancels for all the home health Requests for Anticipated Payment (RAPs) that were rejected in error between 6/5/17 through 8/7/17. 

Provider Action

10.09.2017 – Providers need to monitor their remittance advice for the cancelled RAPs that were originally rejected with reason codes U6815, U6816, U6817, or U6818.  Once they appear on your RA, please resubmit the RAP to process correctly.

Proposed Resolution

10.09.2017 - A system release is scheduled for November 6, 2017, at which time, CGS will initiate adjustments to the claims that were rejected in error.  The adjustments will be completed within 45 days after the November system release is implemented.


Date Reported

Status

Provider Type Impacted

Description of Issue

Reason Codes

Claim Coding Impact

Date Resolved

05.06.2016

Pending

Hospice

An issue has been identified with the 60 day 'high' and 'low' Routine Home Care rate being applied incorrectly with dates of service on or after January 1, 2016.

NA

NA

 

Updates

09.28.2017 - Refer to the MAC Action and the Provider Action section below.
05.30.2017 – Refer to the Provider Action section below.

09.28.2016 – In the August 18, 2016, Provider eNewsExternal PDF 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.

09.16.2016 – Refer to the following articles for additional information:

05.06.2016 – The Centers for Medicare & Medicaid Services (CMS) is aware of, and is researching this issue.

MAC Action

09.28.2017- CGS will initiate the adjustments over the three months following the submission of all lists, concluding the process by January 29, 2018.

Provider Action

09.28.2017 - The Centers for Medicare & Medicaid Services (CMS) issued the MLN Matters® article SE17029, "Process for Hospices to Submit a List of Cliam Requiring Adjustments"External PDF instructing hospice providers to submit a list of claims to be adjusted due to routine home care (RHC) and service intensity add-on (SIA) payment errors. Hospice providers should submit their list of claims to CGS, no later than October 20, 2017, to CGS.MEDICARE.HHH.CLAIMS@cgsadmin.com.
The list of claim information should include only the following:

  • the document control numbers (DCNs) of the claims to be adjusted
  • the dates of service for each claim, and
  • whether the error is related to RHC days or SIA amounts.

DO NOT include personal health information, such as the beneficiary name, and health insurance claim number (HICN).
DO NOT submit a secured email. When your list of claims to be submitted is sent in a secured email, CGS is unable to access the list. Therefore, if you have submitted a secured email, please resend, unsecured.
05.30.2017 – Medicare has corrected most of the system errors associated with 2016 hospice service intensity add-on and RHC payments; however, two issues still remain, which require Hospices to submit adjustments. Refer to the MLN Matters Special Edition article
SE17014External PDF for additional information.

Proposed Resolution

09.28.2017 - Refer to the MAC Action and the Provider Action section below.


Date Reported

Status

Provider Type Impacted

Description of Issue

Reason Codes

Claim Coding Impact

Date Resolved

03.02.2016

Pending

Home Health

01.17.2017 (Home Health) – Some home health claims and adjustments are cycling in FISS in status/location S M90H4 with reason codes E0419, V8029, V8030, and V8031.

03.02.2016 – 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.

E0419, V8029, V8030, V8031, and E46#V

NA

 

Updates

08.01.2017 – Although the July 3, 2017 system release did allow some claims to process from the status/location S M90H1, an additional resolution is needed. At this time, the additional resolution has not been scheduled for release. Please note that CGS continues to explore manual workarounds to allow these claims to process.

05.30.2017 (Updated 06.09.2017) – At this time, adjustments (TOB XXG) continue to suspend in status/location S M90H4 and S M90H1. Additional issues related to the value codes were discovered. FISS maintainers have scheduled a resolution for implementation on July 3, 2017. Please note that this resolution does not address final claims.

12.01.2016 – 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.

05.06.2016 – 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.

03.02.2016 – 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.

MAC Action

NA

Provider Action

NA

Proposed Resolution

NA


Two Vantage Way, Nashville, TN 37228 ©2017 CGS Administrators, LLC. All Rights Reserved