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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
11.06.2019 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 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.
10.17.2019 – closed Our processing system added CPT modifier 51 to CPT codes 97140, 97112, and 97530. Services denied due to invalid procedure code/modifier combination.
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.
10.09.2019 CGS has been notified by CWF that beneficiary eligibility dates may be missing from the CWF beneficiary files. They have received many examples and will be looking into the issue. This will affect eligibility inquiries using the myCGS portal, Interactive Voice Response (IVR) system and the CWF eligibility systems, ELGA/ELGH.
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.
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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