Corporate

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 CorrectionPDF" 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 CorrectionPDF" 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. 1External PDF, § 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.

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