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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
04.17.2020 - Closed HCPCS code J3301 was added to the Self-Administered Drug list in error. This caused claims to deny stating "No coverage when self-administered."
04.17.2020 CGS is aware of delays in answering questions that have been submitted to the mail box. Our resources have been focused on getting payments made and we are now working through the questions that have been submitted. It may take a few days to work through all the questions but you will get a response as quickly as possible.
04.16.2020 We are researching telehealth (audio and visual) claims denying for modifier 95. No provider action needed at this time.

**NOTE: Providers who conduct audio-only communication (no video or visual) may bill CPT codes 98966-98968 and CPT codes 99441-99443. It is not necessary to append the 95 modifier to these telephone codes, as these are not face-to-face services.
02.04.2020 Denial of debridement of mycotic nails that do not require a class findings modifier.
02.03.2020 – Closed All anesthesia codes billed with dates of service 01.01.2020 through 02.05.2020 were priced at the incorrect amount.
02.03.2020 – Closed With the January Release, the type of service for CPT code 77063 changed, but all system indicators were not. This resulted in erroneous denials for invalid procedure code and place of service. Services that paid applied to deductible or co-insurance in error. In Kentucky, some claims billed with CPT modifier 26 denied for missing the mammogram certification number, which is not required for an interpretation.
01.21.2020 – Closed Payment for CPT codes 80061, 82465, 84478 and 83718 (KY only) was reduced in error.
12.19.2019 – Closed CGS determined that in Ohio Part B, we were incorrectly paying HCPCS code A9500 at a flat rate of $121.70 per unit instead of by invoice
11.06.2019- Closed The Centers for Medicare & Medicaid Services (CMS) has identified an issue with obtaining current MSP information via the HIPAA Eligibility Transaction System (HETS). This affects MSP information available in myCGS, and the interactive voice response (IVR) system.
10.25.2019 – Closed The myCGS portal remittance advices are masking the Patient Account Numbers with Xs. However, the MLN Matters article MM11289 explains that the first five digits of the patient control number or patient account number (ACNT) will be masked the SSN or HIC are a part of the patient control number or ACNT.
10.15.2019 It has come to the attention of the Centers for Medicare & Medicaid Services (CMS) that the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) edit 7275 is denying Part B ambulance claims inappropriately. This is occurring when the beneficiary is in a covered Part A SNF stay but requires a Part B covered transport for emergency services and when the transport claim is billed with Healthcare Common Procedure Coding System (HCPCS) code A0427, A0429, or A0433.
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.

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