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 |
---|---|---|---|---|---|---|---|---|---|
02/28/2025 | Suppliers that submit claims for HCPCS code Q0511 or Q0512 for a supply fee billed with Oral Anti-Cancer Drugs or Oral Anti-Emetic Drugs. | 96 | Q0511 or Q0512 | Claims received 02/21/2025–02/28/2025 for HCPCS Code Q0511 or Q0512 may have denied in error if billed with Oral Anti-Cancer Drugs or Oral Anti-Emetic Drugs. | CGS will reprocess claims that denied in error. | No action needed. | Claims denied in error will be adjusted. | 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: 02.28.2025