J15 Part A Claims Processing Issues Log
Listed below are current system-related claims processing issues that have been reported to the Centers for Medicare & Medicaid Services (CMS) and/or the Fiscal Intermediary Standard System (FISS) Maintainer. This information is made available and updated as we have new information or updates to share, so you may review prior to contacting the Part A Provider Contact Center. A list of resolved issues is also available at the end of this list. If you still have questions, please call 866.590.6703.
|Reason Code/Status Location
|Influenza and Pneumococcal Vaccines not Pricing
||Certain influenza and pneumococcal vaccine codes are not pricing on claims even though the vaccine administration is paying.
This issue is being researched and a ticket has been submitted to the FISS maintainer. Once the issue is resolved providers can adjust their claims to have the vaccines reimbursed.
|Reject Code 36342
||Reject code 36342 was set up in error to claim level reject ESRD claims instead of line level.
The reason code was corrected on January 25, 2017 to line level reject correctly. If there are claims that rejected the entire claim prior to January 25, 2017, providers may adjust the rejected claims either electronically or through DDE.
|Reason Code 32352
||Certain claims were RTP'd in error, stating the type of bill is invalid for the HCPCS code.
There are additional claims for multiple HCPCS that are in RTP status due to a file maintenance issue. Providers will be notified once the corrections have been implemented.
|Reason Code 34943
||Some ESRD claims (72X type of bill) were RTP'd in error due to an issue with the system edit.
This issue is resolved. If there are claims that are not processing as they should, notify the PCC at the number listed above.
This issue has been addressed. However, if you identify additional claims in RTP status with reason code 34943, F9 or resubmit the claims for correct processing.
|CGS has determined that there are claims that have RTP'd in error with reason code U6833/U6832.
This reason code states that "Medicare is billed as secondary payer due to a non-GHP; however, there is no matching diagnosis(es) on the claim and the non-GHP record(s) on CWF."
CGS is submitting Electronic Correspondence Referral System (ECRS) requests to the Benefits Coordination & Recovery Contractor (BCRC) on these claims. Providers can expect 30 days for normal claims processing time. Remarks on the claim will indicate that an ECRS has been submitted.
CGS is aware of the issue and is working on a resolution. If you have claims that you believe are RTP'd in error, F9 the claims or resubmit, and the claims will be suspended until the correction is implemented.