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 |
---|---|---|---|---|---|---|---|---|---|
03/05/2024 |
Suppliers that submit claims for HCPCS codes A6530, A6533-A6541, and A6549. |
151 |
Lymphedema Compression Items. HCPCS codes A6530, A6533-A6541, and A6549. |
Claims for dates of service 01/01/2024 and after for HCPCS codes A6530, A6533-A6541, and A6549 are denying in error when three units of service are billed. |
CGS will reprocess claims that denied in error. |
No action needed. |
Editing will be set up to prevent the incorrect denial, and claims denied in error will be adjusted. |
In Progress |
TBD |
02/28/2024 |
Suppliers that submit claims for HCPCS codes A4604, A7030, A7027, A7034, A7037 |
151 |
A4604, A7030, A7027, A7034, A7037 |
Claims with a date of receipt of 02/14/2024 may have denied in error for over the frequency limits. |
CGS will reprocess claims that denied in error. |
No action needed |
Editing has been corrected and any claims that denied in error will be adjusted. |
In Progress |
TBD |
01/16/2024 |
Suppliers that submit claims for HCPCS codes A4238 and A4239 with a number of services greater than one. |
151 |
A4238 and A4239 |
Claims for dates of service 01/01/2024 and after for codes A4238 and A4239 are denying in error when more than one unit of service is billed. |
CGS will reprocess claims that denied in error with ANSI Remark Code MA01 due to Medically Unlikely Edits (MUEs). |
No action needed. |
Editing will be set up to prevent the incorrect denial and claims denied in error will be adjusted. |
In Progress |
TBD |
11/06/2023 |
Suppliers who submit claims to the DME MAC when the from date of service equals the date of discharge from home health services and the beneficiary is no longer a patient. |
97 |
Home Health Consolidated Billing for the following: Urological, Ostomy, Tracheostomy, Surgical Supplies. |
This issue affects claims with dates of service on and after 01/01/2022 in which the date of service equals the date of discharge from home health services and the beneficiary is no longer a patient. These claims may be denying incorrectly for a home health episode. |
Claims with incorrect denials will be adjusted when brought to the DME MACs attention via a redetermination request. |
If the denial is incorrect, submit a redetermination for correction. |
Editing will be corrected at the Common Working File, (CWF) to prevent the incorrect denials and recoupments. |
In Progress |
TBD |
02/01/2019 |
Suppliers of HCPCS codes E1020, E1028, E2228, 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 |