Part A Open Claims Processing Issue Log
Providers/
Date
Issue/ Reason
Updates/ Work Around/
Workload
Description
Reported
Code
Scheduled Fix
Impacted
39930
SNF TOB 22X claims are receiving 10/24/12: The FISS Maintainer has
10/24/12 Part A
Providers
created FS6848 to correct this issue.
reason code 39930 in error.
There is currently a production date
of 04/01/13.
N/A
08/06/12: The system maintainer
Some remittances from 08/02/12
07/07/12 Part A
Providers
has provided a fix to recreate
were not generated.
remittances for 08/02/12. Providers
that previously received the
remittance dated 08/02/12 may
receive a duplicate remittance for
that date.
Location
There are currently several
06/14/12: We are working with the
06/14/12 Part A
Providers SM95HG
adjustments suspended in location
FISS and HIGLAS Maintainers to
SM95HG due to various HIGLAS
correct this issue.
errors.
No provider action is needed.
32304
Claims are receiving Reason Code 03/22/12: The issue has been
03/22/12 Part A
Claims
32304. The IDE number is not
reported to FISS and a PAR has been
transferring between original claims opened and is currently unscheduled.
and adjustments.
32813
Claims are receiving Reason Code 03/22/12: The issue has been
03/22/12 Part A
Claims
32813 incorrectly for HCPC J8530 reported to FISS and a PAR has been
with diagnosis code 203.00 on the
opened and is currently unscheduled.
claim.
02/28/12 Part A
Providers
Correction of The MSP Covered days are not
MSP Covered being properly reflected in value
Days
code 80. This should be the MSP
utilized days returned from
MSPPAY. Value codes 82 and 83
should also be reduced accordingly
along with value codes 08, 09, and
10.
10/24/12: The FISS Maintainer is
still researching this issue.
06/27/12: This appears to still be an
issue after FS6489 was installed.
The FISS Maintainer is researching.
02/28/12: The FISS Maintainer has
created FS6489 to correct this issue.
There is currently a production date
of 06/04/12.
02/10/12 All Part A
Providers
10/24/12
No provider action is needed.
38038, 38074, Currently, the duplicate claim reason 02/12/12: The FISS maintainer will
38151, 38033, codes 38038, 38074, 38151, 38033 be making system changes to correct
and 38154
and 38154 are applying to Inpatient the logic in the listed reason codes
Part A Open Claims Processing Issue Log
Providers/
Date
Issue/ Reason
Workload
Reported
Code
Impacted
12/07/11 Part A
Providers
11/01/11 Part A
Providers
08/12/11 Part A
Providers
Description
Ancillary claims (Type of Bill 12X)
or Outpatient claims (Type of Bill
13X) when the “Through Date” of
the Outpatient claim is the same as
the “From Date” of the Inpatient
Ancillary claims. ` These reason
codes should not edit when the
discharge date of the outpatient
claim overlaps the same date of
service as the admission date of
Inpatient the Ancillary claim.
Some claims Claims submitted with a value in
submitted in CTP04 (Drug Quantity) are
the 5010
rejecting: 277 “CSCC A7:
format with
Acknowledgement /Rejected for
drug
Invalid Information”. CSC 697:
information
“Too many decimal positions” CSC
are rejecting 216: “Drug information 2410.CTP04
inappropriately is limited to 3 decimal positions”.
on the 277CA.
The July 2011 Claims submitted with HCPCS/CPT
system release codes affected by this issue are
incorrectly
denying incorrectly with reason code
affected
51MUE or 52MUE.
Medically
Unlikely Edits
(MUEs) for
several
HCPCS/CPT
codes.
Updates/ Work Around/
Scheduled Fix
with Change Request 7699 in the
July 2012 quarterly release.
Cahaba will be suspending these
claims to SMOLAP to manually
work until CR 7699 is installed.
12/07/11: Reported to translator
vendor. There is no ETA at this time.
01/06/12: An implementation date
still has not been scheduled.
11/15/11: Added 52MUE as a reason
code
11/01/11 Cahaba is awaiting further
reprocessing instructions from the
Centers for Medicare & Medicaid
Services (CMS) at this time.
10/24/12: FS6234 has a production
date of 12/03/12.
38031, 38032, Outpatient claims are receiving
38200
reason code 38031 (for possible
duplicate) instead of 38032 or 38200
(for exact duplicate) when
01/06/12: FS6234 has not been
appropriate.
scheduled for a release yet
11/23/11: FS6234 is still in research
status. A fix has not been scheduled.
10/05/11: FS6234 is still in research
status. A fix has not been scheduled.
10/24/12
Part A Open Claims Processing Issue Log
Providers/
Date
Issue/ Reason
Workload
Reported
Code
Impacted
Description
Updates/ Work Around/
Scheduled Fix
09/07/11: FS6234 is still in research
status. A fix has not been scheduled.
08/12/11: This problem has been
reported to FISS under FS6234 and
00074414. A fix has not been
scheduled.
If you feel you received a duplicate
claim rejection in error, please
submit an adjustment to the original
claim that was processed to
completion or request an appeal.
Please refer to J10 AB MAC
Medicare News 6/22/11 for
information on how to file claims to
avoid a duplicate rejection.
10/24/12