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Claim Payment Alerts
Please reference this page for information about confirmed, system-related issues before you reach out to Customer Service. Click on the description to view details and check back often for updates that we post when they become available.
Closed issues remain on the active log for approximately 60 days before they move to the resolved issues archive list at the bottom of the page.
If you still have questions, please contact Customer Service or use one of our self-service tools.
| Date Reported |
Description of Issue |
| 11.21.2025 |
Claims for COVID and other vaccines provided on the same day denied in error. |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Part B |
|
Date of service 10.01.2025 or after; CPT code 90480 |
|
MAC Action |
CGS will download the January 2026 NCCI PTP edits file on or about 11.24.2025. Within 30 business days, CGS will adjust impacted claims or adjudicate appeals to allow payment if there’s no other reason to deny. |
Provider Action |
N/A |
Proposed Resolution |
This issue is a result of National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) edits tied to CPT code 90480 (COVID vaccine administration) implemented on October 1, 2025. Therefore, CMS is expediting the implementation of the January 2026 NCCI PTP edits file. |
|
| 11.07.2025 |
The Common Working File (CWF) Host identified an issue that caused a subset of HMO beneficiary claims to deny (no open HMO enrollment) in error. |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Closed |
Part B |
Audit 341A, CWF error code 5232 |
|
11.13.2025 |
MAC Action |
11.24.2025 – We released all suspended claims, and new claims should process as usual.
Suspend claims (location 240) until the issue is resolved. |
Provider Action |
N/A |
Proposed Resolution |
11.13.2025 – The issue is resolved. Due to volume, we’ll release claims in batches. CGS will provide updates once the CWF Host notifies us that the issue is resolved. |
|
| 11.05.2025 |
Clinical Lab Service denying due to a missing, incomplete, or invalid Clinical Laboratory Improvement Amendments (CLIA) certification number. |
| Status |
Provider Type Impacted |
Reason Codes |
Claim Coding Impact |
Date Resolved |
Open |
Part B (KY and OH) |
MA 120 and 284 |
Clinical Laboratory |
|
| MAC Action |
N/A |
| Provider Action |
Ensure your laboratory's CLIA certification is current and covers all billed specialties and subspecialties. |
| Proposed Resolution |
Contact your state's CLIA office to verify your certification status including billed specialties and subspecialties. Resubmit claims.
CLIA offices:
Kentucky
Ohio |
|
Updated: 11.24.2025