EDI Status

CPILClaims 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
01.24.2019 A system edit allowed the payment of vaccine administration codes when the vaccine was not submitted on the claim. This has resulted in overpayments.
01.16.2019 – closed Based on expanded coverage for Intensive Cardiac Rehabilitation (ICR) provided by the Bipartisan Budget Act (BBA) of 2018, the Centers for Medicare & Medicaid Services (CMS) has added several diagnosis codes for chronic heart failure to the national coverage determination (NCD) for ICR services.
10.24.2018 – closed An audit that denies CPT codes with a 'ZZZ' global period when the primary code is not billed was inadvertently disabled from September 6 - October 24, 2018. Codes that should have denied were paid in error.

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