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 |
---|---|---|---|---|---|---|---|---|---|
05/07/2025 | Suppliers that submit claims for HCPCS code J7601 with the KO modifier. | N/A | J7601KO | Claims for dates of service 04/01/2025 and after for HCPCS code J7601KO may have processed with the incorrect fee amount when billed as Ohtuvayre® (Ensifentrine). |
CGS will reprocess claims that processed with the incorrect drug fee based on the CMS quarterly average sales price (ASP) files. | No action needed. | Errors in claims processing will be corrected, and measures have been put in place to prevent future occurrences. | 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: 07.03.2025