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: 04.14.2025