Print |
Bookmark |
|
Font Size:
+ |
–
Claim Payment Alerts
Please reference this page for information about confirmed, system-related issues before you reach out to the Provider Contact Center. Click on the description to view details and check back often for updates that we post when they become available.
Closed issues remain on the active log for approximately 60 days before they move to the resolved issues archive list at the bottom of the page.
If you still have questions please contact the Provider Contact Center or use one of our self-service tools.
Date Reported |
Description |
11.14.2024 |
Hospice Certifying Physician Claim Edit, Reason Codes 17729 and 17730 |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Hospice providers |
17729 and 17730 |
N/A |
|
MAC Action |
|
Provider Action |
Please ensure the billing instructions below are being followed.
On October 7, 2024, additional implementation edits on hospice claims for hospice certifying physician Medicare enrollment requirements were implemented. Business Requirements (BRs) 13531.3, 13531.3.1 and 13531.4 will be implemented on November 18, 2024. The edits are to occur only If the incoming hospice claim contains occurrence code 27 and the date of certification. The editing is occurring without the claims containing occurrence code 27 and the date of certification.
Claim Physician Billing Information
- For admission claim submissions (occurrence code 27 and the date of certification matches the claim’s admission and "from" dates) prior to November 18, 2024, the attending field must be populated a physician.
- If there is not an attending physician designated by the patient, enter the hospice certifying/recertifying physician
- Do not enter a nurse practitioner (NP) or physician assistant (PA) serving as an attending in this field prior to November 18, 2024, only physicians, to avoid a 17729 denial
- For admission claim submissions (occurrence code 27 and the date of certification matches the claim’s admission and "from" dates) on or after November 18, 2024, the attending field may be populated a physician, NP or PA serving as an attending.
- If there is not an attending physician designated by the patient, enter the hospice certifying/recertifying physician
- The patient’s designated attending physician could be an independent physician, hospice physician, an NP or PA
- For all non-admission claim submissions (admission date and claim "from" date do not match), regardless of submission date:
- Attending Physician Field
- Enter the name and NPI of the attending physician designated by the patient
- If there is not an attending physician designated by the patient, enter the hospice certifying/recertifying physician
- The patient’s designated attending physician could be an independent physician, hospice physician, an NP or PA
- Referring Provider Field
- Enter the name and NPI of the hospice’s physician responsible for certifying patient’s terminal illness
- When no attending is designated or the attending physician is also the certifying physician, only populate the attending physician field
|
Proposed Resolution |
|
|
08.15.2024 |
Reason Code U538H: An Eligibility Database (EDB) update that incorrectly identifies some beneficiaries as incarcerated caused the Common Working File (CWF) to reject claims in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
HH&H providers |
U538H |
N/A |
|
MAC Action |
09.26.2024 – CGS will also adjust impacted claims not captured in the claim hold process within 30 business days.
09.23.2024 – CGS will release suspended claims for processing. NOTE: This includes any Informational Unsolicited Response (IUR) adjustments for claims that processed after the incarceration date. These claim rejections are valid.
CGS will suspend claims to status/location (S/LOC) S MINCR until the issue is resolved. |
Provider Action |
No provider action. |
Proposed Resolution |
09.23.2024 – The CWF Host sites were updated with clean incarceration data from the EDB.
CMS is researching to determine how to correct the incarceration date for impacted beneficiaries and process claims that rejected in error. |
|
07.29.2024 |
Reason Code 32073: A system outage at the Virtual Data Center (VDC) caused home health claims to return to the provider (RTP) in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Home Health |
32073 |
TOB 34X |
|
MAC Action |
CGS will suspend claims until a resolution is determined. |
Provider Action |
|
Proposed Resolution |
In research |
|
07.03.2024 |
Reason Codes 326XX: One or more payer only codes may assign to a claim and cause it to return to provider (RTP) in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Home Health & Hospice |
326XX |
Payer only code(s) |
|
MAC Action |
CGS removed value code Z9 from RTP claims submitted prior to, or during the installation of, the July 2024 release on 7.1.2024. |
Provider Action |
Remove any payer only codes before you F9/resubmit RTP claims or submit an adjustment or cancel claim.
Refer to the CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 1, section 190 for a complete list of payer only codes. |
Proposed Resolution |
A system fix is scheduled with the April 2025 release. |
|
02.14.2024 |
Reason Code U523A: Some hospice claims rejected in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Hospice |
U523A |
|
|
MAC Action |
N/A |
Provider Action |
N/A |
Proposed Resolution |
08.22.2024 – CGS will adjust affected claims once we receive additional instructions.
04.29.2024 – CGS received additional claim examples after the system update was installed. We will continue to research and provide an update when available.
03.18.2024 – A system update was installed.
Currently in research. |
|
08.01.2023 |
Reason Code 19963: Some home health claims returned to provider (RTP'd) in error because the corresponding NOA is offline. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Home Health |
19963 |
NOA in Status/Location (S/LOC) O B9997 |
|
MAC Action |
02.22.2024 –CGS was not able to restore/process all affected NOAs/claims. See Provider Action update below.
10.06.2023 – CGS will restore the affected NOAs and process the associated claims within 45 calendar days.
08.23.2023 – A system update will not allow additional NOAs to move offline. |
Provider Action |
02.22.2024 – If you identify NOAs/claims that CGS was not able to restore/process per the MAC Action on 10.06.2023, please fax your list of claims to 615-660-5982.
Review claims that RTP with RC 19963. If a claim doesn't meet the criteria above, correct and resubmit it. |
Proposed Resolution |
See MAC Action and Provider Action.
Update: A system fix is scheduled for the January 2025 release. |
|
01.11.2023 |
Reason Code 31755: Some home health claims returned to provider (RTP'd) in error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Home Health |
31755 |
See Provider Action. |
|
MAC Action |
|
Provider Action |
As of January 3, 2023, home health claims should RTP when the revenue code 0023 line-item date of service doesn't match the date of the first home health visit.
- For initial and subsequent periods of care, report the date of the first covered visit provided during the period on the revenue code 0023 line.
- For subsequent periods, do not report the first day of the period. Report the first visit date whether it was covered or non-covered.
Reference Chapter 10 – Home Health Agency Billing.
If applicable, correct the date(s) of service and resubmit the claim.
If you identify a claim that meets the following criteria, call the Provider Contact Center (PCC). Once validated, the PCC will submit a request for Claims to bypass the edit.
- December 2021 billing period start dates that span to 2022
- January 2022 billing period start dates that used the artificial admit date
|
Proposed Resolution |
See Provider Action. |
|