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Claims Processing Issues Log
Listed below are current system-related claims processing issues. Issues are shown by date reported with the most recently reported issue listed first. This log is updated frequently, as soon as information becomes available. CGS encourages you to review this log often and prior to contacting the Provider Contact Center. A list of resolved issues is also available at the end of this list. If you still have questions, please contact the Provider Contact Center or use one of our self-service tools.
Date Reported |
Description of Issue |
10.07.2024 |
Provider remits displayed an incorrect Patient Responsibility Amount. The affected Claims are Non-Assigned claims only, for Kentucky and Ohio remits. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Closed |
Part B KY and OH |
N/A |
Multiple |
10.18.2024 |
Updates |
Issue has been resolved. |
MAC Action |
All remits have been corrected and reissued |
Provider Action |
No action is required. |
Proposed Resolution |
CGS has released corrected Provider remits for all non-assigned claims affected. |
|
07.25.2024 |
Claims have denied for CLIA in error. This caused many lab codes to hit a Common Working File (CWF) Error. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Part B Providers that bill for Lab Services |
The claims were denied with with message Reason Code B7 |
Lab Codes |
|
Updates |
The issues have been resolved as of 09/25/2024 |
MAC Action |
All claims affected will be reprocessed. |
Provider Action |
Claim adjustments will begin within the next 30 days. |
Proposed Resolution |
|
|
04.03.2024 |
Claims received with codes CPT 93297 and 93298 with a 26 modifier have been rejected. |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Part B KY and OH |
N/A |
Multiple |
|
Updates |
|
MAC Action |
We will perform a mass adjustment to reprocess the claims that were denied in error. |
Provider Action |
No action is required. |
Proposed Resolution |
CGS has completed the systems update to allow CPT codes 93297 and 93298 when billed with a 26 modifier. |
|
01.16.2024 |
Claims received for both states KY and OH for CPT codes 72050, 72080, 72100, 72114, 72190, 72200 and 73030 that were denied in error when billed by provider type 38 (NP- Nurse Practitioner or CNS - Clinical Nurse Specialist) |
Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Part B Type 38 (NPs and CNS) Providers |
N/A |
CPT codes 72050, 72080, 72100, 72114, 72190, 72200 and 73030 billed by type 38 providers |
|
Updates |
|
MAC Action |
CGS will perform a mass adjustment to correct claims that denied. |
Provider Action |
No action is required. |
Proposed Resolution |
CGS will perform a mass adjustment to correct claims that denied. |
|