Claim Payment Alerts
Date Reported | Provider Type Impacted | Reason Codes | Claim Coding Impact | Description of the Issue | Action Required by the MAC | Action Required by the Provider | Proposed Resolution/Fix | Status | Date Resolved |
---|---|---|---|---|---|---|---|---|---|
02/27/2025 |
Suppliers who submit claims for Capecitabine (Xeloda) billed with HCPCS code J8999 instead of the appropriate National Drug Code (NDC). |
N/A |
J8999 |
Claims with a receipt date of 01/01/2025–02/19/2025 with dates of service 01/01/2025–02/19/2025. Claims for HCPCS code J8999 may have processed with the incorrect fee amount when billed as Capecitabine (Xeloda). |
CGS will reprocess all claims billed with HCPCS Code J8999 and will convert the HCPCS code to the NDC for dates of service 1/1/2025–2/19/2025. Claim adjudication and payment information will be provided on a remittance advice. |
To ensure proper payment, suppliers should reference the February 19, 2025, news article titled Capecitabine Oral Anti-Cancer Drug Billing Instructions. |
Claims processed in error will be adjusted and preventive measures have been established. |
In Progress |
TBD |
02/01/2019 |
Suppliers of HCPCS codes E1020, E1028, E2368, E2369, E2370, E2375, K0015 and K0070 |
96 |
E1007, E1020, E1028, E2228, E2368, E2369, E2370, E2375, K0015 and K0070 |
Claims for HCPCS codes E1020, E1028, E2228, E2368, E2369, E2370, E2375, K0015 and K0070 may have denied incorrectly due to a system processing issue. NOTE: This is an ongoing issue with no ETA for resolution. |
The issue causing the claim processing error cannot be corrected at this time. |
No action required. |
A report will be run monthly and claims will be adjusted if the denial was incorrect. |
NA |
NA |
02/01/2019 |
Suppliers of wheelchair accessories. |
151 |
Wheelchair accessory HCPCS codes. |
Claims for wheelchair accessories may have denied as same or similar equipment incorrectly due to a system processing issue. NOTE: This is an ongoing issue with no ETA for resolution. |
The issue causing the claim processing error cannot be corrected at this time. |
No action required. |
A report is run monthly, and claims are adjusted if the accessories were denied incorrectly. |
NA |
NA |
Updated: 04.04.2025