Skip to main content

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


For some hospice adjustments the end of life (EOL) Service Intensity Add-On (SIA) payment is not being made. This applies to some adjustments with dates of services prior to January 1, 2020, that were received on or after January 1, 2020.


Physician charges on hospice claims (revenue code 0657) received by CGS between 10.07.2019 – 01.05.2020 were overpaid.


When a claim is entered via the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) with the Medicare Beneficiary Identifier (MBI), and when pressing F9 a reason code displays, the MBI changes to a Health insurance Claim Number (HICN). If the reason code is resolved, and the claim is stored, the claim is sent to the Return to Provider (RTP) file with reason code 30995 in error.


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.


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.


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.

Was this page helpful? YES NO

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