License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

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Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
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April 17, 2018

Suspended Claims Reminder

The Home Health and Hospice Provider Contact Center (PCC) have received an increase in calls from providers with questions about claims that are in a suspended status/location. This article serves as a reminder about how claims process through the Fiscal Intermediary Standard System (FISS).

As billing transactions processes in FISS, they move through various stages of the system. Each stage is identified by a status/location that can provide information about what's happening to the claim.

Status Code "S" and Locations
The status code "S" means the claim is suspended for processing. Locations further define what is happening with the billing transaction. Locations are 5-character positions. There are thousands of status/location combinations. Listed below are the most common status/location combinations and what they mean.

Status/Location "X" denotes various alpha/numeric characters	Description
S B0100	System processing (billing transaction is suspended).
S B6000	Billing transaction goes to this location for 1 day, prior to moving to S B6001 to generate the additional development request (ADR).
S B6001	Additional information is being requested from the provider. An Additional Development Request (ADR) will be generated from this location. Documentation in response to Medical Review ADRs (MR ADRs) must be received by CGS within 45 calendar days. Refer to the Additional Development Request (ADR) Overview Web page for additional information.
S M50MR	Medical review of documentation. The billing transaction will move to this location after the Additional Development Request (ADR) information has been received. Please note that the review process may take up to 30 days to complete or 60 days for demand denials (condition code 20).
S B90XX	Data on the billing transaction is being verified with the beneficiary eligibility information posted at the Common Working File (CWF).
S MXXXX	Billing transactions are suspended in this location when Medicare staff intervention is needed. May be suspended for about 30 days. (See below for additional information.)
S M87DR	Hospice Only – acknowledgement that CGS has received the documentation for an exception request for an untimely notice of election. Refer to the "Requesting an Exception for an Untimely NOE" Web page for additional information.
S M87RE	Hospice Only – the documentation provided in the Remarks field for an exception request for an untimely notice of election is being reviewed.
S M8877	Hospice Only – if documentation for an exception request for an untimely notice of election is not received within 30 days of the initial request, the claim will move to this status/location until day 45, or until your documentation is received. If documentation is not received by day 46, the claim will be released to process as billed. Refer to the "Requesting an Exception for an Untimely NOE" Web page for additional information.
S MRADJ	MSP adjustment – created after MSP adjustment received: awaiting completion.
T B9900	Billing transaction will need correction by the provider when it moves into T B9997 in the next system cycle.
T B9997	Billing transaction needing correction by providers will appear in this location. Refer to the Fiscal Intermediary Standard System Guide, "Chapter Five: Claims Correction" for information about correcting billing transactions. Assistance is also available on the "Top Claim Submission Errors (Reason Codes) and How to Resolve" Web page.
I B9900	Billing transactions that are inactivated from Return to Provider (RTP) file; waiting to purge from FISS.
R B9997	Rejected billing transaction (finalized).
R B75XX	Rejected billing transaction (suspended). It may take at least 75 days for the claim to move to the R B9997 finalized status/location.
D B9997	Denied claim (all services denied). A partially denied claim will appear in the P status.
P B7501	Post-pay MSP review.
P B7505	Post-pay MSP review.
P O9998	Archived claim. Refer to the Fiscal Intermediary Standard System Guide, "Chapter Five: Claims Correction" for information about accessing archived claims.
P B9996	Billing transactions have been posted and are awaiting the payment floor.
P B9997	Billing transactions have been processed and paid (full or partial).

Note:Claims with Medicare Secondary Payer (MSP) information may be suspended for more than 60 days. Providers may call the Provider Contact Center if a claim has been in the same "S MXXX" status/location for longer than 30 days, or 60 days for MSP claims.

To determine when a claim moved to the current status/location, access FISS Claim Page 02, and press F2. In the example below, this billing transaction moved to status/location S M50MR on March 28, 2018. Refer to the Checking Claim Status for additional information.

Screen Shot

As a reminder, the Medicare Claims Processing Manual (Pub. 100-04, Ch. 1, § 80.2.1.1) states that Medicare contractors have 30 days to process clean claims. While the typical timeframe to process claims is less than this, contractors have the full 30 days from the receipt date of a clean claim to process it. Please note that home health Requests for Anticipated Payment (RAPs), hospice Notices of Election (NOEs) and adjustments have no specified timeframe for processing.

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

Suspended Claims Reminder

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