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 |
04/22/2025 | Suppliers that submit claims for HCPCS codes E1032–E1034 as a purchase with the NU modifier and the item is billed with a complex power wheelchair base submitted as an initial purchase. | 108 | E1032NU E1033NU E1034NU | Claims for dates of service 04/01/2025 and after for HCPCS codes E1032NU E1033NU, and E1034NU are denying in error. The Common Working File (CWF) does not have codes E1032NU E1033NU, or E1034NU included in CWF editing. |
CGS will reprocess claims that denied in error with ANSI Remark Code N130: This HCPCS code must be billed as a capped rental unless used with a complex rehab wheelchair. This equipment is only covered when rented. | No action needed. | CMS implemented proactive measures to prevent this denial. CGS is collaborating with the CWF to put preventative measures in place. Claims that were denied in error will be corrected. |
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: 05.09.2025