Part A Closed/Archived Claims Processing Log
Date
Reported
Providers/
Workload
Impacted
07/03/12 Inpatient
Claims
06/27/12 Part A
Providers
Issue/ Reason
Code
34931/34932
V8015
Description
Updates/ Work Around/
Scheduled Fix
Resolution Date
There is an issue with
4010 inpatient claims
not retaining the POA
indicator. FS6716R1
has been created for
this and it is
scheduled for a future
release. Reason codes
34931 and 34932 are
being set to suspend
to location SMREL1
until FS6716R1 is
implemented on
08/02/12.
08/02/12: FS6716R1 was
07/06/12: FISS
determined on 07/05/12 installed to correct the
that reason code 34931 is issue.
not an issue. Reset
34931 to RTP and
recycling claims.
Providers should correct
the POA indicator and
resubmit. Reason code
34932 will suspend and
be manually worked
until FISS installs the
fix.
V8015 received and
deductible amount is
greater than billed
charges – there is no
known workaround
for this issue and
these claims will need
to pend until
FS6512R1 is
distributed.
09/12/12: FS6512R1 has
been installed into
production. All claims
that were pending have
now been released for
processing.
07/03/12: FS6716R1 is
scheduled to be
implemented 08/02/12.
09/12/12: FS6512R1 has
been installed into
production.
CMS has issued
instructions for
contractors to pend
claims billed that receive
reason code V8015.
These claims will pend
in status/location
SMTDLI.
No provider action is
required.
06/27/12
10/1/12
Part A
Providers
Reason Codes
39930 and
39927
Coinsurance and
deductible are not
applying correctly for
TOB 72X when billing
J3370. Claims are
being held in
Status/Location
07/06/12: CR7593R1 was
installed into production on
07/02/12. Cahaba GBA
has released previously
held claims.
06/27/12: The FISS
07/06/12: CR7593R1 was
installed into production
on 07/02/12.
Cahaba GBA has released
previously held claims.
Part A Closed/Archived Claims Processing Log
SMTDLP.
Maintainer has created
CR7593R1 to correct this
issue. There is currently a
production date of
07/02/12.
No provider action is
needed.
04/02/12
Part A
Providers
Reason Code
7TDLO
Coinsurance and
deductible are not
applying correctly for
TOB 72X with dates of
service on or after
01/01/12 billing J3370
with the AY modifier.
07/06/12: CR7593R1 was
installed into production on
07/02/12. Cahaba GBA
has released previously
held claims.
07/06/12: CR7593R1 was
installed into production
on 07/02/12.
Cahaba GBA has released
previously held claims.
06/27/12: CR7593U did
not correct this issue. The
FISS Maintainer has
created CR7593R1 which
currently has a production
date of 07/02/12.
04/02/12: TDL 12313
instructed contractors to
hold claims for 72X TOB
with dates of service on or
after 01/01/12 billing
J3370 with the AY
modifier. The FISS
Maintainer has created
CR7593U to correct this
issue. There is currently a
production date of
05/07/12.
No provider action is
needed.
07/18/11
Part A
Providers
31953
Reason code
information is not
populating on page 32
of the claim.
07/06/12: Fix was put into
production on 06/04/12.
No provider action
required.
01/06/12: FS6379R1 has
been scheduled to go into
production 6/4/12
11/23/11: An
implementation date has
not yet been scheduled.
10/1/12
07/06/12: Fix was put into
production on 06/04/12.
No provider action
required.
Part A Closed/Archived Claims Processing Log
07/18/11 The FISS
Maintainer has created
FS6379R1 to resolve this
issue. An implementation
date has not yet been
scheduled.
No provider action is
required.
03/08/12 Part A
Providers
77641
TOBs 13X, 71X,
77X, and 85X
reporting HCPCS
G0447
07/24/2012 CR7641 was 07/24/12
installed into production
on 07/02/2012. Cahaba
GBA has released
previously held claims.
03/08/12: CR7641
instructed contractors to
hold claims for 13X,
71X, 77X, and 85X TOB
for claims received
before 07/02/12.
03/08/12 Part A
Providers
77610
TOBs 13X, 71X,
77X, and 85X
reporting HCPCS
G0445
No provider action is
needed.
07/24/2012 CR7610 was 07/24/12
installed into production
on 07/02/2012. Cahaba
GBA has released
previously held claims.
03/08/12: CR7610
instructed contractors to
hold clams for 13X,
71X, 77X, and 85X TOB
for claims received
before July 2, 2012.
No provider action is
needed.
03/07/12
10/1/12
Part A
Providers
Devices Codes Claims are RTP'ing
for 2012
with reason code
W7077 and W7071 for
claims lacks allowed
procedure code and
claim lacks allowed
07/06/12: CR7841 I/OCE
was installed into
production on 07/02/12
with release C2012300.
07/06/12: CR7841 I/OCE
was installed into
production on 07/02/12
with release C2012300.
Part A Closed/Archived Claims Processing Log
device code. Claims
will be held in status
location SMTDLJ.
Cahaba GBA has released Cahaba GBA has released
previously held claims
previously held claims
06/25/12: CR7841 will be
installed on 07/02/12.
04/09/12: CMS has issued
a TDL 12315 to hold
claims until the July 2012
I/OCE is released and
installed.
03/07/12: FISS is aware of
this problem and has
opened a HPAR
CR7668H1 to CMS for
clarification.
No provider action is
needed at this time.
05/21/12
Part A
Providers
Billing for
Ambulance
Services
Reason Code
TOBs 13X, 22X, 23X,
E9206 Claims or 85X
will be held in
Status/Location
SMTDLK.
07/06/12: CWF CR28788
was installed into
production on 07/02/12
with release C2012300.
07/06/12: CWF CR28788
was installed into
production on 07/02/12
with release C2012300.
Cahaba GBA has released Cahaba GBA has released
previously held claims.
previously held claims.
05/21/12: Alert Gins
XFS04626 instructed
contractors to hold claims
billed with HCPC A0425,
A0427, A0429, A0430,
A0431, A0432, A0433,
A0434, A0435 OR A0436
and A0428 for claims with
date of service on or after
04/01/12. The FISS
Maintainer has created
CWF CR 28788 to correct
this issue. There is
currently a production date
of 07/02/12.
Any claims that were
RTP’d in error will be
identified and reprocessed.
Claims will be held in
10/1/12
Part A Closed/Archived Claims Processing Log
Status/Location SMTDLK.
No provider action is
needed.
12/29/11
02/07/12
Part A
Providers
All Rural
Health Clinic
(RHC)
Providers
34931
39930
Change Request 7680
updates the list of ICD9-CM codes exempt
from POA reporting for
discharges on or after
10/1/11. Inpatient
claims received with a
POA Exempt ICD-9CM code effective
10/1/11 will receive
reason code 34931.
These claims will be
RTP’d requesting a
valid POA indicator.
070/3/12: CR7680 was
07/03/12
implemented and the POA
indicator of “W” as a
workaround is no longer
needed. Claims should be
filed with the appropriate
POA indicator.
12/29/11: CR7680 is
planned to be implemented
on 07/02/12. CMS has
created a workaround to
resolve this issue by adding
POA indicator “W” to the
affected ICD-9-CM code
instead of leaving it blank.
Coinsurance is applying 06/25/12: CR7208R4 was 06/25/12
incorrectly to RHC
installed with release
claims with Preventive C20122UF on 06/04/12 all
Services.
claims cycling for RHC
providers have been
released.
04/17/12: CR7208R4 has
been scheduled for
06/04/12.
02/07/12: The claims are
cycling with reason code
39930. The issue has been
reported to the system
maintainer. The issue will
be corrected with
installation of CR7208R4.
A production
implementation date has
not yet been determined.
No provider action is
required.
04/02/12
10/1/12
Part A CAH
Providers
77314
TOBs 85X reporting
Modifier 22
06/25/12: CR7287U was
installed with release
06/25/12
Part A Closed/Archived Claims Processing Log
C20122UF on 06/04/12.
04/02/12: TDL 12314
instructed contractors to
hold claims for 85X TOB
for claims received
beginning 04/02/12 billed
with Modifier 22. The
FISS Maintainer has
created CR7587U to
correct this issue. There is
currently a production date
of 06/04/12.
No provider action is
needed.
03/08/12
Part A
Providers
77637
TOBs 13X, 71X, 77X,
and 85X reporting
HCPCS G0444
06/25/12: CR7637 was
installed on 04/02/12 and
claims have been released
for processing.
06/25/12
03/08/12: CR7641
instructed contractors to
hold clams for 13X, 71X,
77X, and 85X TOB for
claims received before
04/02/12.
No provider action is
needed
03/08/12
Part A
Providers
77633
TOBs 13X, 71X, 77X,
and 85X reporting
HCPCS G0442 and
G0443
.
06/25/12: CR7633 was
installed on 04/02/12 and
claims have been released
for processing.
06/25/12
03/08/12: CR7641
instructed contractors to
hold clams for 13X, 71X,
77X, and 85X TOB for
claims received before
04/02/12.
No provider action is
needed.
03/08/12
10/1/12
Part A
Providers
77636
TOBs 13X, 71X, 77X,
and 85X reporting
HCPCS G0446
06/25/12: CR7636 was
installed on 04/02/12 and
claims have been released
06/25/12
Part A Closed/Archived Claims Processing Log
for processing.
03/08/12: CR7641
instructed contractors to
hold clams for 13X, 71X,
77X, and 85X TOB for
claims received before
04/02/12.
No provider action is
needed.
03/07/12
05/30/12
Part A
Reason Code
Laboratory
E0014
DEMO Claims
Part A
Providers
Some LAB claims are
receiving Reason Code
E0014 incorrectly for
Dates of Service prior to
01/01/2012. These
claims are currently
RTP’ing while FISS
investigates.
Claims Cycling When an INP claim is
with CWF 5052 received at a host, and
the host does not have
the HIC number in the
database the CWF
software generates a
TNIF 50 – but the HITN
(request for HIC
information from CMS)
is not being generated
therefore the TNIF 50 is
never getting overlaid
with the TNIF 52 to
allow the claim to
process.
06/25/12: FISS created
06/25/12
FS6733 and implemented
fix into production on
06/04/12. Please resubmit
any claims that RTPd
incorrectly.
03/07/12: The issue has
been reported to FISS and
they are investigating.
05/30/12: If you have
06/25/12: If you have
claims that you feel RTPd claims that you feel RTPd
incorrectly please resubmit. incorrectly please
resubmit.
Claims that were at CWF
when the CWF release was
installed will require more
than 2 cycles to get the
correct reply. Once claims
receive the correct reply
they may receive additional
CWF disposition codes
and/or reason codes that
require additional claims
processing time.
These claims are
looping in FISS.
04/30/12
Part A
Providers
31313
5010 Payer information
isn’t mapping correctly
causing claims to
incorrectly RTP with
reason code 31313.
05/08/12
Part A
Providers
56900
Some of the Additional 05/08/12: Until the issue
06/01/12: We are in the
Development Request can be corrected providers process of identifying
(ADR) letters are being are encouraged to view
claims that denied in error
10/1/12
04/30/12: FISS PAR
06/11/12: PAR was moved
FS6728 was created to
to production on 6/4/12.
correct the problem.
Production installation date
is tentatively scheduled for
06/04/12.
Part A Closed/Archived Claims Processing Log
05/04/12
03/22/12
Part A
Providers
Part A
Providers
returned because the full
address is not printing
on the letter and are
undeliverable. In some
cases claims may be
denied with reason code
56900 (requested
documentation not
received).
ADR letters online in FISS.
The letters can be viewed
online using menu 01 –
Inquiries, then sub menu
12 – Claim Summary. On
the Claim Summary
Inquiry menu enter the
facilities NPI number and
S/LOC SB6001. Print a
copy of the external
narrative to be mailed as
the first page of the
requested documentation.
Write the DCN and HIC
number on the external
narrative.
with reason code 56900.
The identified claims will
be reprocessed. You may
receive a request for
records when the claims
are reprocessed.
Claims Cycling When an INP claim is
with CWF 5052 received at a host, and
the host does not have
the HIC number in the
database the CWF
software generates a
TNIF 50 – but the HITN
(request for HIC
information from CMS)
is not being generated
therefore the TNIF 50 is
never getting overlaid
with the TNIF 52 to
allow the claim to
process.
05/08/12: CWF Special
Release R20122OS will be
implemented in production
and claims will be moved
to the appropriate location.
No provider action is
needed.
05/16/12: Fix has been
verified, claims are
processing as expected.
Reason Code
C7252
05/04/12: CWF PLOG
28774 has been created and
a fix will be coming as
soon as possible.
These claims are
looping in FISS.
Reason Code C7252 is 05/07/12: FS6698 was
applying at the claim
installed in production on
level instead of the line 05/07/12.
level.
03/22/12: The FISS
Maintainer has created
FS6698 to correct this
issue. An implementation
date has not yet been
scheduled.
As a workaround, C7252
has been manually updated
to assign at the line level
rather than the claim level.
10/1/12
Providers should refile any
claims that they feel were
rejected or RTPd for 5052
in error.
05/07/12: Providers can
resubmit any claims that
were rejected in error.
Part A Closed/Archived Claims Processing Log
Providers can resubmit any
claims that were rejected in
error.
03/22/12
Part A
Providers
Reason Code
C7565
Reason Code C7565 is 05/07/12: FS6698 was
applying at the claim
installed in production on
level instead of the line 05/07/12.
level.
03/22/12: The FISS
Maintainer has created
FS6698 to correct this
issue. An implementation
date has not yet been
scheduled.
05/07/12: Providers can
resubmit any claims that
were rejected in error.
As a workaround, C7565
has been manually updated
to assign at the line level
rather than the claim level.
Providers can resubmit any
claims that were rejected in
error.
01/09/12
Part A
Providers
Providers are
only able to
view the first
two pages of the
eligibility
screen
01/05/12
Part A
Providers
31313
12/29/11
Part A
Providers
33249
Providers are unable to
F8 beyond page two of
the Beneficiary
Eligibility Screen
01/09/12: Issue was
reported to the system
maintainer on 01/03/12 via
question 76404. Multiple
MACs have added
comments to the question
indicating their users are
experiencing the problem.
5010 Payer information 01/05/12: FISS PAR
isn’t mapping correctly FS6580 was created to
causing claims to
correct the problem.
incorrectly RTP with
Production installation date
reason code 31313
not available at this time.
CMS has issued
instructions for
contractors to hold
claims billed with
HCPCS code 33249.
03/02/12: PAR CR7470S1
was installed with release
C201214F on 02/05/12.
03/02/12: PAR FS6580
will be installed with
release C20121UF
scheduled to go in
03/05/12
12/29/11: The claims shall 02/07/12: This one was
be held until R11220S1 has added in error.
been successfully installed.
Implementation date is
scheduled for 02/06/12.
No provider action is
required.
12/29/11
10/1/12
Part A
Providers
73249
CMS has issued
instructions for
contractors to hold
claims billed with
HCPCS code 33249.
12/29/11: The claims shall 02/07/12: All claims have
be held until R11220S1 has been resolved.
been successfully installed.
Implementation date is
Part A Closed/Archived Claims Processing Log
scheduled for 02/06/12.
No provider action is
required.
10/18/11
Part A
Providers
C7111
CWF is incorrectly
setting A/B crossover
edit 7111 when the
incoming or history
claim from and thru
dates are equal and the
patient status is 20.
01/06/12: CWF has an
implementation date of
4/2/12
11/10/11: The SCF CR is
in a work status and has the
target implementation date
of April 2012.
04/05/12: CWF CR28178
was implemented on
04/02/12. If claims were
RTPd in error please
resubmit.
10/18/11: The fix is being
worked under CWF CR
28178. There is no
implementation date
currently.
10/07/11
Part A
Providers
31313
Claims are suspending
incorrectly with 31313
10/07/11: FISS is
researching this issue.
No provider action is
required.
Providers can update any
claims that are RTP’d for
31313 and change the
release of information
value to Y or I, and F9 the
claim after the changes
have been made.
10/03/11
All Rural
Health Clinic
(RHC)
Providers
7JPRE
CMS has issued
instruction for
contractors to hold
claims billed with
HCPCS codes for
Preventive Services due
to an overpayment
issue.
11/23/11: An
implementation date still
has not been scheduled.
10/14/11: The reason code
31313 narrative is being
updated by FISS to state
that only the entry of Y
and I can be used on DDE,
Hardcopy, and 5010A2
claims.
01/06/12: CR7208R3 was
installed production on
01/03/12with release
C2012100.
10/03/11: The claims shall
be held until CR7208R3
Cahaba GBA has released
has been successfully
previously held claims.
installed. An
implementation date has
not yet been scheduled at
this time.
No provider action is
required.
09/21/11
10/1/12
Outpatient Part WW020 for
A Claims
Healthcare
Common
CMS has instructed
contractors to hold
claims billed with
11/23/11: The expected
release date remains
04/13/12: File fix done to
release any claims being
held.
Part A Closed/Archived Claims Processing Log
09/21/11
09/13/11
Part A
Providers
Part A
Providers
submitting
roster bills
Procedure
Coding System
(HCPCS) code
90654
HCPCS code 90654 for 4/4/12.
dates of service May 9,
2011 through April 1, 09/21/11: These claims
2012.
will be held until CMS
issues claims processing
instructions via a Change
Request. The expected
release date is 04/02/12.
HCPC codes
74176, 74177
and 74178
Claims with HCPCS
codes 74176, 74177 or
74178 processed from
January 2011 through
July 2011 may have
rejected in error with
reason code C7252.
09/21/11: Providers can
submit adjustments on
claims that were processed
incorrectly.
Some roster bills are
receiving this reason
code in error.
09/13/11: FISS PAR
CR7128R2 has been
written to correct this issue.
The fix is currently being
tested and is scheduled to
be moved to the production
region 10/03/11.
31596
Providers may submit any
adjustments they feel were
not correctly selected in
the mass adjustment.
No provider action is
required.
09/07/11 Part A
Providers
Cancel claims When a cancel claim
remaining in is submitted before
PB9996
the original claim is
finalized, the cancel
claim remains in
PB9996.
07/05/12: FS6640
currently has a
production date of
09/04/12.
02/13/12: PAR FS6640
was opened by system
maintainer. They are
currently working on a
resolution for processing
the claims hung up in
PB9996.
01/19/12: System
maintainer is actively
working on a resolution.
12/29/11: Issue was
discussed on a
conference call with
10/1/12
09/27/11: Cahaba has
completed mass
adjustments on claims
meeting these criteria.
10/05/11: CR7128R2 was
installed into production
10/03/11 with release
C201141S.
Claims should no longer
receive this error.
Providers should now be
able to process/submit
affected claims.
10/1/12 Cancel claims that
were stuck in status
location PB9996 have been
moved to PB9997. Special
remittances were generated
and will be mailed to the
affected providers.
Part A Closed/Archived Claims Processing Log
CMS, the system
maintainer and the
MACs. All participants
are working on
resolution to finalize the
cancel claims currently
in PB9996.
12/04/11: FS6278 was
installed in production
120411. New cancel
claims will no longer
stop processing and hang
up in status location
PB9996. The fix didn’t
resolve cancel claims
currently hung up in
status location PB9996.
FISS question 75885
was opened asking the
system maintainer for
direction on how to
finalize the cancel claims
currently in PB9996.
11/23/11: Scheduled
implementation date of
12/5/11.
09/07/11: FISS PAR
FS6278 was written to
correct the problem and
is scheduled for
implementation into the
production region on
12/5/11.
09/06/11
Part A
Providers
FSS02400 AT: Claims are receiving the
08200
following ABEND
message: “FSS02400
Status is:
AT: 08200 Status is:
ABEND
ABEND”
08/19/11
Part A
Providers
31953,
WW019, 39910
and adjustment
reason codes
34304, 34299,
10/1/12
09/06/11 FISS PAR
CR7142R1 will be
implemented to correct the
problem and is scheduled
for 10/03/11.
Cahaba is experiencing 08/19/11: We have
an increased volume of implemented a project to
Part A claims.
reduce our inventory. We
anticipate our reduction
Our top three suspense efforts to be complete by
10/03/11: FISS PAR
CR7142R1 was installed
10/03/11 to correct the
issue
10/31/11: Inventory has
been reduced
Part A Closed/Archived Claims Processing Log
08/08/11
08/10/11
Part A
Providers
and 34009
reason codes are 31953, October 2011.
WW019, and 39910.
There is no action required
Our top three
on behalf of the provider
adjustment reason codes community.
are 34304, 34299, and
34009.
39934
Claims are rejecting
with reason code 39934
at line level, causing a
discrepancy of liability
at the claim level. The
claims should be
rejecting at claim level
for 39934 and should be
rejected with a different
reason code at the line
level.
FISS has scheduled a fix to 09/06/11: This issue has
be implemented September been corrected with
6, 2011.
FS6310.
SNF claims (21X TOB)
billed with the default
HIPPS code of AAA00
are being returned
because the claims do
not contain an
occurrence code 50 with
the assessment
reference date. This edit
is in error since the
default code does not
require an occurrence
code 50 and the date.
12/01/11: CR7019R7 did 01/04/12
not correct this issue. The
FISS maintainer has
created CR7019R8 to
correct the issue with a
scheduled production date
of 12/5/11.
Skilled
31742 with
Nursing
default HIPPS
Facility (TOB code AAA00
21X)
No provider action is
required.
11/23/11: CR7019R7 did
not resolve the issue, under
investigation.
10/28/11: CR7019R7 has a
scheduled production date
of 11/07/11.
These claims are currently
being suspended and will
be released once this
correction is successfully
installed to production.
10/05/11: FISS has still not
scheduled an
implementation date.
08/10/11 The FISS
Maintainer has created
CR7019R7 to correct this
issue. An implementation
date has not yet been
10/1/12
Providers should resubmit
claims that rejected 39934
in error.
Part A Closed/Archived Claims Processing Log
scheduled.
No provider action is
required.
07/29/11
Part A
Providers
31644
Adjustments performed 01/06/12: Cahaba GBA has 10/31/11: All claims have
per TDL 11363 are
completed manually
been processed
being Returned to the
processing these claims.
Provider (RTP) in error.
07/29/11 Cahaba GBA will
be manually processing
these claims.
No provider action is
required.
07/22/11
07/19/11
Part A
Providers
Part A
Providers
Inpatient
Pricing
Inpatient claims
are receiving
reason codes
37001 and
30022.
SNF inpatient
claims are
paying at the
incorrect rate.
10/1/12
Per CMS, a problem has 07/22/11: A new pricer is
been identified with the being developed and is
IPPS Pricer for FY2010. expected to be available for
FISS testing later in July.
Two of the IPPS pricer Incoming inpatient claims
calculation modules are and adjustments for dates
of service 10/01/09 through
flipped in the most
09/30/10 are being held
recent version of the
pending successful testing
IPPS Driver module.
HPAR CR7244H7 was and installation of the new
pricer.
written to verify that
PPCAL10E should be
used for claims with
discharge dates from
10/01/09 through
03/31/10, and
PPCAL10F should be
used for claims with
discharge dates from
04/01/10
09/07/11: The new
inpatient pricer was
installed into production
09/06/11.
The Core-Based
Statistical Area (CBSA)
and Metropolitan
Statistical Area (MSA)
codes are missing from
the provider file,
causing inpatient claims
to suspend and SNF
inpatient claims to be
paid incorrectly.
10/14/11: The issue has
now been resolved and any
claims that were suspended
for 37001 or 30022 have
been released
10/04/11: Inpatient claims
are again receiving reason
code 37001. FISS is
currently researching the
issue. No provider action is
required.
09/12/11 – Inpatient claims
are no longer receiving
37001 and suspending.
Cahaba GBA has released
claims suspending for
37001. FISS has scheduled
a fix for 30022 to be
implemented 10/03/11.
Cahaba GBA has released
previously held claims.
Those claims that were
processed incorrectly will
be identified and
reprocessed with the
correct pricer.
Part A Closed/Archived Claims Processing Log
Once the fix is
implemented, Cahaba GBA
will release suspended
claims for 30022. No
provider action is required.
07/25/11 – SNF inpatient
claims are also paying at
the incorrect rate due to the
CBSA and MSA codes
missing from the provider
file. Cahaba will identify
and adjust these claims
once the provider files are
updated.
07/13/11-FISS is currently
researching the issue.
FS6432 has been created to
address this issue.
No provider action is
required.
05/17/11
Part A
Providers
Hepatitis B
Hospital outpatient
Vaccine Codes claims with dates of
90740-90747
service on and after
January 1, 2011,
containing the HCPCS
codes 90740, 90743,
90744, 90746, and
90747 are incorrectly
applying coinsurance
and are being
suspended.
Hospital-based Renal
Dialysis Facilities
(RDFs) claims with
dates of service on and
after January 1, 2011,
containing HCPCS
codes 90743 and 90744
are not applying
payment on the
Hepatitis B vaccine
code line and are being
suspended. Freestanding RDFs claims
with dates of service on
10/1/12
08/17/11: The fix for this
issue was implemented
8/8/11. Cahaba has
released suspended claims
for processing. All
outpatient OPPS claims
that have incorrectly paid
or applied deductible or
coinsurance will be
adjusted to correct the
payment, coinsurance and
deductible by August 31,
2011.
07/18/11: FISS has
scheduled CR7012R6 to be
implemented 8/8/11.
06/30/11: FISS has
scheduled CR7012R6 to
correct this issue. An
implementation date has
not been scheduled.
Per JSM 11311, the Fiscal
Intermediary Shared
09/07/11: Cahaba GBA
has adjusted all claims that
incorrectly paid or applied
deductible or coinsurance.
Part A Closed/Archived Claims Processing Log
and after January 1,
2011, containing
HCPCS code 90744 are
not applying payment
on the vaccine code line
and are being
suspended.
Systems (FISS) maintainer
has created CR7012R5 to
modify these codes to
properly apply
payment. This release does
not have an
implementation date.
No provider action is
required.
05/17/11
Part A
Providers
Hepatitis B
vaccine
administration
code G0010
Outpatient Prospective
Payment System
(OPPS) claims with
dates of service on and
after January 1, 2011,
containing Hepatitis B
vaccine administration
code G0010, are
erroneously receiving
deductible and
coinsurance and are
being suspended.
06/30/11: FISS has
scheduled an
implementation date of
07/06/11.
Per JSM 11311, changes
necessary to correct this
issue will be implemented
in the July 2011 Integrated
Outpatient Code Editor
(IOCE) release.
No provider action is
required.
05/17/11
Part A
Providers
Critical Access
Hospitals
(CAH)
containing
HCPCS codes
Q0091, G0101,
77052, 77057,
and G0202
CAH claims with dates
of service on and after
January 1, 2011,
containing the HCPCS
codes listed are
incorrectly applying
coinsurance and are
being suspended
07/18/11: The fix for this
issue was implemented
070/3/11.
Cahaba has released
suspended claims for
processing. All outpatient
OPPS claims that have
incorrectly paid or applied
deductible or coinsurance
prior to the installation of
the July IOCE release that
corrected this issue will be
adjusted to correct the
payment, coinsurance and
deductible by August 31,
2011.
06/30/11 Update: FISS has 07/18/11: The fix for this
scheduled an
issue was implemented
implementation date of
07/03/11.
07/06/11.
Cahaba has released
Per JSM 11311, the Fiscal suspended claims for
Intermediary Shared
processing. All claims that
Systems (FISS) maintainer have incorrectly paid or
has created CR7012R5 to applied coinsurance prior
modify these preventive
to the installation of the
service codes to properly release that corrected this
apply and display
issue will be adjusted to
coinsurance. This release correct the payment and
does not have an
deductible by August 31,
implementation date.
2011.
No provider action is
required.
05/17/11
10/1/12
Part A
Providers
E461J
Claims with dates of
service on and after
January 1, 2011,
containing surgical
60/30/11: FISS has
scheduled an
implementation date of
07/06/11.
07/18/11: The fix for this
issue was implemented
7/3/11.
Part A Closed/Archived Claims Processing Log
procedure codes 1000069999 with PT modifier
are receiving reason
code E461J and are
being suspended due to
deductible incorrectly
being applied.
Per JSM 11311, changes
necessary to correct this
issue will be implemented
in the July 2011 Integrated
Outpatient Code Editor
(IOCE) release.
No provider action is
required.
05/17/11
05/17/11
Part A
Providers
IPF PPS
Claims
Federally
Qualified
Health Centers
(FQHC) claims
containing
Preventive
Service Codes
G0402, G0389,
Q0091, G0101,
G0130, 7707877081, 77083
and 76977
FQHC claims with dates
of service on and after
January 1,2011,
containing the HCPCS
codes listed are
incorrectly applying
coinsurance and are
being suspended
38311
Claims that the patient
is being transferred to
another facility that is
not part of the same
hospital.
Per JSM 11311, the Fiscal
Intermediary Shared
Systems (FISS) maintainer
has created CR7012R5 to
modify these preventive
service codes to properly
apply and display
coinsurance. This release
does not have an
implementation date.
No provider action is
required.
06/28/11: The fix for this
issue is scheduled to be
implemented 7/5/11.
Cahaba has released
suspended claims for
processing. All claims that
have incorrectly paid or
applied deductible prior to
the installation of the July
IOCE release that
corrected this issue will be
adjusted to correct the
payment and deductible by
August 31, 2011.
07/18/11: The fix for this
issue was implemented
7/3/11.
Cahaba has released
suspended claims for
processing. All claims that
have incorrectly paid or
applied coinsurance prior
to the installation of the
release that corrected this
issue will be adjusted to
correct the payment and
deductible by August 31,
2011.
07/05/11: The fix for this
issue was implemented
7/5/11.
This issue has been
Providers should resubmit
reported to the system
claims that rejected 38311
maintainer in question
in error.
73844. System maintainer
has created CR7072S1 to
address the issue of 38311
assigning incorrectly.
There is not an
implementation date at this
time.No provider action
required.
05/17/11
Part A
Providers
LCD L30048
Claims meeting
Mass adjustments for these 06/27/11: Cahaba has
payment criteria denied claims will be initiated
completed mass
incorrectly with 5094E, 5/23/11.
adjustments.
53000 or 53013/53003.
05/17/11
Part A
Providers
LCD L30035
Claims meeting
payment criteria denied
incorrectly with 5209E,
53000 or 53013/53003.
10/1/12
05/17/11: Mass
adjustments for these
claims will be initiated
5/23/11.
06/27/11: Cahaba has
completed mass
adjustments.
Part A Closed/Archived Claims Processing Log
05/13/11
Part A
Providers
submitting
roster bills
31596
Roster bills are
receiving reason code
31596 in error.
05/13/11: FISS has
scheduled PAR CR7234R2
to be implemented with
C2011300 release on
07/05/11.
07/18/11: PAR CR7234R2
was installed with release
C2011300 as scheduled.
Providers should resubmit
claims that were suspended
FISS PAR CR7234R2 has in a return status (TB9997)
been written to correct the in error.
issue but has not been
scheduled for a release.
No provider action is
required.
04/12/11
Part A
Providers
C7111
CWF is incorrectly
setting A/B crossover
edit 7111 when the
claim in history is not
the same IPPS hospital
(Acute Care) or Critical
Access Hospital (CAH)
as the incoming claim.
04/12/11: Issue has been
reported to CWF under
PLOG 00028030.
Reason Code C7111 has
been updated to suspend
internally rather than
returning back to the
provider until a resolution
is determined.
06/09/11: The CWF fix
has been installed and all
claims have been released
for processing. Providers
should resubmit any claims
that may have rejected in
error.
No provider action is
required.
04/07/11
SNF and
Swing Bed
12900
SNF and Swing Bed
claims with occurrence
code 50 are being RTPd
in error.
Reason Code 12900 has
been updated to suspend
internally rather than
returning back to the
provider. The issue has
been reported to the FISS
system maintainer.
Research is still being done
by the maintainer to
determine exactly what is
causing the error.
05/10/11: CR7019R4 was
installed on 5-8-11 and
corrected this issue.
Suspended claims have
been released for
processing.
No provider action is
required
04/07/11
SNF and
Swing Bed
31742
SNF and Swing Bed
Reason Code 31742 has
claims are being RTP'd been updated to suspend
in error.
internally rather than
returning back to the
provider pending
installation of CR7019R4
scheduled for May 9, 2011.
Provider Action: Claims
10/1/12
05/10/11: CR7019R4 was
installed on 5-8-11 and
corrected this issue.
Suspended claims have
been released for
processing.
Part A Closed/Archived Claims Processing Log
that were returned in error
for this reason code can be
resubmitted by pressing
F9. These claims will be
released when CR7019R4
is installed.
04/04/11
Part A
Providers
11701 and
11801
Reason codes 11701
and 11801 are being
applied to hardcopy
claims with receipt
dates 04/01/11 and
greater in error.
04/12/11: CMS has
temporarily inactivated
these reason codes for
hardcopy claims pending
CR7202S
This issue has been
reported to FISS system
maintainer and scheduled
to be resolved with the
installation of CR7202S on
05/09/11.
05/09/11: CR7202S1 was
installed into production
05/09/11(C201127F).
These reason codes have
been re-activated.
For claims that have RTPd,
providers may enter an
admission type and
resubmit. If admission type
is unknown, enter “9” as
admission type.
Cahaba GBA is
implementing an internal
work around in the interim
to prevent these claims
from being RTPed.
Providers can resubmit
claims that RTPed in error
by pressing the F9 key.
03/15/11
Provider
billing therapy
HCPCS codes
listed in CR
7050
Claims
Coinsurance payment is
submitted with incorrectly calculated.
the following
therapy HCPCS
codes:
92506, 97016,
97124, 92507,
97018, 97140,
92508, 97022,
97150, 92526,
97024, 97530,
92597, 97026,
97533, 92607,
97028, 97535,
97116, 97032,
97537, 92609,
97033, 97542,
96125, 97034,
97750, 97001,
97035, 97755,
97002, 97036,
10/1/12
06/05/11: CR7050R4 has
been scheduled to be
implemented with
C20112VF. The FISS
Maintainer has scheduled a
production date of 6/6/11.
06/22/11: This issue has
been resolved with the
installation of CR7050R4
in release C20112VF,
installed into production
06/12/11.
05/10/11: CR7050R3
installed 5-8-11 did not
correct coinsurance issues
with the HCPCS codes
listed. The FISS System
Maintainer has now written
CR7050R4 to correct this
issue but no release date
has been scheduled.
Cahaba GBA has begun
initiating adjustments to
previously submitted
claims.
03/15/11: The issue has
been reported to the system
maintainer. The issue will
be corrected with
installation of CR7050R3.
Part A Closed/Archived Claims Processing Log
97760, 97003
97110, 97761,
97004, 97112
97762, 97012,
97113, G0281,
G0283, G0329
A production
implementation date has
not yet been determined.
Once the fix is installed,
previously submitted
claims will be adjusted.
No provider action is
required.
03/15/11
02/04/11
Outpatient Part 71169
A Claims
SNF and
Swing Bed
E51#R
CMS issued instruction
for contractors to hold
claims billed with
HCPCS codes 97597 &
97598
The claims will be held
until the Integrated
Outpatient Code Editor has
been updated.
04/04/11: The latest IOCE
available from CMS was
installed into the
production region 04/03/11
by CDS.
Cahaba has released claims
to follow normal
processing procedures.
Claims that span 2010 02/17/11:The FISS system 4/13/11: This issue has
and 2011 on the same
maintainer has created
been resolved with the
claim are receiving this CR7019R2 to resolve this installation of CR7019R2.
reason code in error.
issue. However, FISS has
not yet scheduled an
All claims that suspended
implementation date for
in error have been released
this fix. Claims will
for processing.
continue to suspend
internally. No provider
action is required.
This issue has been
reported to the FISS
system maintainer in
question 72244. FISS has
examples and is
researching the issue for
resolution. Claims are
suspending internally. No
provider action is required
at this time.
02/09/11
10/1/12
ESRD
TOB 72X
CMS has identified a
problem with the ESRD
pricer incorrectly
pricing home dialysis
claims containing
condition code 74 with
revenue codes 0841 and
0851. The payment is
not being correctly
Updates/Work
Around/Scheduled Fix
CMS has instructed
Cahaba to hold all ESRD
72X bill types with dates of
service on or after 01/01/11
that contain condition code
74, with either revenue
code 0841 or 851 until the
02/23/11 – The pricer was
implemented into
production 02/21/11.
Suspended claims were
released beginning
02/22//11.
Mass adjustments were
Part A Closed/Archived Claims Processing Log
adjusted for the daily
rate resulting in
overpayments for these
claims.
revised ESRD Prices has completed 02/22/11.
been released. The pricer is
expected to be in
production by February 21,
2011, and we will release
the held claims
immediately upon
installation of the revised
pricer. We have also been
instructed to adjust any
claims that were paid
incorrectly within 30 days
of the installation.
Cahaba has suspended
these claims to location
SMESR1 with reason code
WW175.
02/01/11
Part A
Providers
39927 and
39930
Reason codes 39927
and 39930 are being
applied to claims in
error. The deductible
and coinsurance is being
incorrectly applied to
preventive care claims.
02/21/11: The FISS
System fix implemented on
02/07/11 did not correct
this issue. The FISS
System Maintainer has
now scheduled CR7012R3
to be implemented
04/04/11 to resolve these
reason codes. Claims will
continue to suspend. No
provider action is required.
05/11/11: CR7012R4 was
installed 05/09/11 and
corrected this issue.
Suspended claims have
been released for
processing
02/01/11: Claims with
these reason codes will be
suspending internally,
pending the FISS System
Maintainer release
scheduled for 02/07/11.
01/27/11
Part A
Providers
37002
No provider action is
required.
Reason code 37002 is The FISS maintainer has
being applied to claims found that this issue is in
with DRG 014 and 015 the pricer module and will
in error.
be corrected with
CR7004S2 that will be
installed with release
C20111UF on 03/07/11.
No provider action is
required.
10/1/12
03/08/11: FISS System
Maintainer installed this
fix 03/07/11. All claims
have been released for
processing.
Part A Closed/Archived Claims Processing Log
01/27/11
Part A
Providers
32704
Reason code 32704 is
being applied to claims
in error. The reason
codes were originally
set to RTP the claims
but now these claims
will suspend.
01/26/11
All Providers
32816
Claims are suspending
with reason code in
error.
01/20/11
All Rural
Health Clinic
(RHC)
Providers
N/A
Coinsurance is being
incorrectly calculated.
Claims suspended with this
reason code will be worked
internally until the FISS
system maintainer corrects
the problem causing the
claims to suspend in error.
04/04/11: PAR CR6851R3
was installed with release
C201121S and resolves the
issue with this reason code.
The status location will be
changed back to “T”,
which will return the
Providers can resubmit the claims to the providers.
claims that RTP’d in error
by pressing the F9 key.
Cahaba will also be
retrieving claims that
RTP’d in error with reason
code 32704.
The issue has been
reported to the FISS
System Maintainer by
multiple contractors in
question 71974. The reason
code has been updated to
suspend claims internally
to a unique status location
and will be released as
soon as the FISS system
maintainer provides a fix.
No provider action is
required.
12/19/11: Cahaba GBA has
begun initiating
adjustments to previously
submitted claims that
applied coinsurance
incorrectly.
11/16/11: In UAT, will
implement 12/5/11.
07/05/11: FISS system
maintainer has rescheduled
the implementation of PAR
FS6217. The new release is
C20114UF which has a
production date of
December 2011.
05/11/11: FS6217- RHC
Psych coinsurance fix is
scheduled for
10/1/12
04/04/11: PAR CR6851R3
was installed with release
C201121S and resolves the
issue with this reason code.
The status location will be
changed back to “T”,
which will return the
claims to the providers.
12/04/11: FS6217 was
installed in production
12/04/11. Providers can
submit adjustments on
claims that have an
incorrect coinsurance
amount.
Part A Closed/Archived Claims Processing Log
implementation September
2011 (C20113UF); FS6206
– RHC coinsurance for
71X type of bill with 900
Revenue code fix is
scheduled for
implementation June 2011
(C20112UF). Claims will
be automatically adjusted
once these fixes are
implemented.
No provider action is
necessary.
FISS has scheduled a fix in
the September 2011
release.
04/21/11: These issues
have been reported to the
FISS System Maintainer.
PARS FS6206 and FS6217
are being worked by the
FISS System Maintainer to
resolve the issue.
No provider action is
required.
01/05/11
Part A
Providers
using DDE
screens
N/A
Users are unable to key
over a specific page
number to navigate to
another page.
05/09/11: Release
20112UF is scheduled for
06/06/11 to correct this
issue.
07/07/11: Release
20112UF corrected this
issue.
01/05/11: The issue has
been reported to the system
maintainer.
FISS PAR FS6261 has
been written to correct the
issue but has not been
scheduled for a release.
Provider Action: Until a fix
is installed providers can
use the F7 and F8 keys to
page backward and
forward.
01/05/11
10/1/12
Part A
34919, 34929 & Reason codes are
01/25/11: The FISS
03/08/11 - All suspended
Part A Closed/Archived Claims Processing Log
Providers
34931
applied to claim in
error.
System Maintainer
claims for these reason
installed a resolution
codes have been released.
01/21/11 for reason code
Reason codes have been 34929. Suspended claims
updated to suspend
will begin being released
internally rather than
01/25/11.
returning back to the
provider.
01/21/11: The FISS
System Maintainer
installed a resolution
01/14/11. Additional
notification from the FISS
System Maintainer
instructed Cahaba to
deactivate 34919 and
34931. Suspended claims
were released beginning
1/20/11.
01/21/11: The FISS
System Maintainer
installed a resolution
01/14/11. Claims in the
Tennessee region with
reason code 34929 were
released beginning
01/19/11, and claims for
the Alabama and Georgia
reasons were released
beginning 01/20/11. For
these 3 reason codes,
claims that were returned
in error with these reason
codes can be resubmitted
by pressing the F9 key.
01/5/11: The issue has
been reported to the Part A
System maintainer. PAR
CR7024R1 is being coded
to correct the problem. The
resolution has not been
scheduled as this time.
Provider Action: Claims
that were returned in error
with these reason codes
can be resubmitted by
pressing the F9 key.
01/05/11
10/1/12
Part A
31608 and
Reason codes 31608
02/08/11: Cahaba
03/08/11: All claims have
Part A Closed/Archived Claims Processing Log
Providers
17801
and 17801 are applied
to claims in error. The
reason codes were
incorrectly set to RTP.
experienced an issue with
our implementation of the
02/07/11 file fix for reason
code 17801. We have made
adjustments to our files to
ensure the fix will process
correctly the night of
02/08/11. With this fix,
these claims will move
from their current
suspended location
02/09/11 and will follow
normal processing.
02/03/11 Cahaba began
releasing claims held with
reason code 31608 on
February 3.
Providers may resubmit
any claims that were
returned to them with this
reason code (31608) for
reprocessing. Claims
returned to the providers
after 02/04/11 may be
receiving reason code
31608 appropriately.
Providers should correct
these claims according to
the external reason code
narrative before
resubmitting.
01/26/11 Claims with these
reason codes will be
suspending internally,
pending the FISS release
scheduled for 02/07/11.
Claims returned to the
provider using the FISS
RTP process will be pulled
back by Cahaba.
No provider action is
required.
01/19/11: The FISS
System Maintainer
installed a resolution
10/1/12
been released for
processing.
If claims that were
previously in RTP status
with reason code 17801 are
F9’ed back and RTP again,
please check the POA field
and diagnosis codes for
correctness.
Part A Closed/Archived Claims Processing Log
01/14/11. This fix did not
fully resolve the issue.
Some claims will continue
to process while others will
continue to suspend.
Another FISS resolution is
scheduled for production
2/7/11.
01/05/11: The reason codes
have been updated to
suspend internally until the
issue is corrected. The
issue has been reported to
the Part A System
Maintainer.
Providers Action: Claims
currently in TB9997(RTP
status) with reason codes
31608 and 17801 should be
resubmitted by pressing the
F9 key.
01/14/11
36111 and
36222
11/18/10
Part A
Providers
39934
End Stage Renal
Disease (ESRD) claims
are editing in error with
reason code 36111 or
36222 for no Method 1
or Method 2 on file for
home dialysis patients
prior to January 1, 2011;
but the method selection
is on the file.
The FISS System
01/19/11 – This issue has
Maintainer is aware of this been resolved with the
issue and is scheduled
installation of CR7064R3.
01/24/2011.
Claims suspended to
Providers can F9 these
SMMETH-36111 and
claims to suspend to
36222 have been released.
SMMETH.
Providers are unable to
adjust claims that
denied with 39934 and
were deemed as
beneficiary liable in
error.
05/03/10- FS5513R1 will
be installed into production
in June 2010. Once the
PAR is installed providers
will be able to adjust
claims.
Providers can now adjust
their claims. Please add
remarks stating “this
adjustment is related to an
07/23/10 - FS5513R1 was issue previously posted on
installed into production. the Claims Issue Log.”
Providers can now adjust
their claims.
11/18/10 - FS5513R1 did
not correct the issue. FISS
now indicates PAR
FS5513R3 is scheduled to
be installed into production
10/1/12
12/15/10 - PAR FS5513R3
was installed on 12/6/10.
Part A Closed/Archived Claims Processing Log
12/06/10 to correct the
issue.
10/01/10
12/21/10
SNF & Swing 37039
Bed Providers
Part A
Providers
30945
Claims submitted with
HIPPS codes effective
100110 with a from
AND through date of
service 100110 are
incorrectly suspending
with reason code 37039
The issue has been
reported to the system
maintainer. Research is
still being done by the
maintainer to determine
exactly what is causing the
error.
01/03/11 corrected pricer
was installed.
Reason code 30945 is
applied to claim in
error. The reason code
was set to RTP the
claim causing the claim
to RTP in error.
01/04/12: Work around has 01/05/12
been implemented. Claims
will no longer RTP in
error.
Claims that were returned
to the provider in error can
be resubmitted by pressing
the F9 key.
11/23/11: FISS PAR
J30043 still has not been
scheduled for a release.
09/07/11: FISS PAR
J30043 still has not been
scheduled for a release.
FISS PAR J30043 has been
written to correct the issue
but has not been scheduled
for a release yet.
12/21/10: The reason code
has been updated to
suspend internally on a
temporary basis since the
edit can be bypassed by
internal users. However, if
the edit was correctly
assigned to the claim the
claim will be manually
returned to the provider.
12/13/10
10/1/12
Part A Rural
31577
Health Clinics
billing for
Preventive
Services after
January 1,
2011
Effective January 1,
2011, deductible and
coinsurance are waived
for preventive services
billed by RHCs. Change
Request 7208 instructed
RHCs to bill an
additional revenue
line(s) with detail
HCPCS code reporting
for preventive services
to ensure that
JSM 11078 was issued to
contractors to install a
work-a-round for these
claims (TOB 71X) when
revenue code 0520, 0521,
0522, 0524, 0525 or 0528
is billed with more than 1
unit. Contractors shall
ensure the charges
associated with the
preventive services
revenue line are moved to
05/11/11: CR7208R1 was
implemented 04/04/11.
Previously rejected claims
will be adjusted by Cahaba
GBA.
Part A Closed/Archived Claims Processing Log
11/17/10
SNF & Swing 37039
Bed Providers
coinsurance and
deductible are not
applied. However,
system changes for this
instruction will not be
implemented until April
4, 2011
non covered and the
revenue line should be
assigned a provider liable
reason code. Upon
successful implementation
of CR 7208, contractors
shall mass adjust the
claims identified and move
the associated charges for
the revenue lines
containing preventive
services to covered
charges. This is scheduled
for April 2011. No
provider action is required
at this time.
Claims submitted with
HIPPS codes effective
100110 with a from
AND through date of
service 100110 are
incorrectly suspending
with reason code 37039
The issue has been
reported to the system
maintainer. Research is
still being done by the
maintainer to determine
exactly what is causing the
error.
03/08/11 - The corrected
pricer was installed 1/3/11.
Claims are no longer
suspending or RTP-ing in
error.
Claims that were returned
to the provider in error can
be resubmitted by pressing
the F9 key.
10/20/10
09/10/09
10/1/12
Part A
Providers
Part A
Providers
DDE Inquiry
E2602
A Fiscal Intermediary
Standard System (FISS)
Direct Data Entry
(DDE) issue has been
reported – Providers
who access the
Medicare secondary
payer (MSP)
information have
reported that when
searching for
beneficiary eligibility in
FISS DDE under the
claims inquiries menu,
only Page 1 of the MSP
screen is available for
review. The screen will
say Page 1 or 2 but no
data is available for
Page 2.
10/27/10 - Systems
changes are necessary to
correct this issue. The
resolution will be
implemented with FISS
CR6911R1. The changes
have not been scheduled at
this time.
03/08/11 - C201100
installed into production 13-11 and resolved this
issue.
The system maintainer
(FISS) has identified a
10/18/10 Systems changes 12/15/10 - Release
are necessary to correct
C20104UF was installed
Until this issue is resolved,
providers may call
Customer Service to obtain
this information.
Part A Closed/Archived Claims Processing Log
problem with E2602 for
inpatient claims
spanning multiple
years. Value codes 08
and 10 are being
combined into value
code 08.
this issue. The resolution 12/06/10. Claims for this
will be implemented with issue have been released
FISS PAR MO0177. We for processing.
are awaiting a fix from our
system maintainer. This is
currently scheduled to go
into production on
12/6/10. Release
C20104UF
No provider action is
required.
07/07/10
All Part A
Reason codes:
providers
submitting
V8022
occupational,
physical and/or V8024
speech therapy
claims
The standard system
maintainer (FISS) has
identified an issue
regarding
occupational/physical/s
peech therapy
maximums. These
reason codes are applied
to claims when the
therapy maximums have
been met and are
reflected on the
common working file. If
a claim is submitted that
will result in the
maximum being met,
the system is not
applying the reason
code. This causes the
claim to cycle which
prevents completion.
01/06/12: CWF
implemented CWFCR
00027964 in the October
2011 release. We will
monitor claims to make
sure the issue has been
resolved.
11/23/11: Cahaba GBA is
manually working these
claims pending a resolution
from FISS system
maintainer.
04/06/11 – Cahaba GBA is
manually working these
claims pending a resolution
from FISS system
maintainer. No provider
action is required.
03/08/11— FISS system
maintainer is currently
pursuing a temporary
workaround to be
distributed to all
contractors. FISS
anticipates an October
2011 date for the
permanent resolution.
09/09/10- This has been
identified as a CWF issue
rather than a FISS issue.
FS6090 to correct the
V8022/V8024 problem
10/1/12
04/16/12: Have monitored
claims, issue can be closed
Part A Closed/Archived Claims Processing Log
will be installed March
2011.
No provider action is
required.
07/28/10-Systems changes
are necessary to correct
this issue. The resolution
has not been assigned to a
release at this time.
(FS6090)
05/01/10
All Part A
Providers
Reason codes:





07/02/10
All Part A
Providers
34009
34013
34287
34299
34300
Deductible on
MSP claims are
incorrectly
reflected on
remittances.
Claims are rejecting
with these codes
indicating the services
are covered by
automobile, no fault,
medical, or workman’s
compensation
insurance. This is also
occurring when the
provider indicates the
claims in not related in
the remarks section of
the claim.
10/13/10 – A resolution is
scheduled to be installed
on 12/06/10 for these
reason codes. No provider
action is required.
12/15/10 – FISS installed
the fix on 12/06/10.
Providers can submit
adjustments for claims that
rejected in error.
05/12/10 – A resolution
will be installed with the
October 2010 release for
these reason codes. No
provider action required.
Please add remarks stating
“this adjustment is related
to an issue previously
posted on the Claims Issue
Log.”
The standard system
maintainer (FISS) has
identified an issue
regarding incorrect
deductible information
being reported on
remittances.
07/19/10 – Systems
changes are necessary to
correct this issue and the
resolution will be installed
January 2011 with the
C20104UF
release/FS6006.
05/10/10 – Reported to the New claims that are not
Shared Systems
related to the accidents
Maintainer.
shown on CWF should
now process correctly
when billed using Process
E on our website.
No provider action is
required.
10/11/10
10/1/12
Part A
Providers
Invalid
Diagnosis
Codes
Claims received after
10/04/10 are editing for
invalid diagnosis code
with dates of service
9/30/09 through
10/01/10.
The system maintainer
(FISS) is aware of this and
they are working to correct
the issue. Release
R41045S1 has not been
assigned a release date at
this time. Updates will be
posted as they become
available.
12/15/10 - FISS installed
the fix on 12/06/10.
Providers can submit
adjustments for these
claims. Please add remarks
stating “this adjustment is
related to an issue
previously posted on the
Claims Issue Log.”
10/25/10: Release
R41045S1 was installed on
10/25/10. This issue has
been corrected and only
affected EMC claims.
Providers may resubmit
EMC claims previously
affected by this error.
Part A Closed/Archived Claims Processing Log
10/1/10
08/20/10
Part A
Providers
Part A
Providers
51MUE
E51#U
The system maintainer
(FISS) has identified a
problem with 51MUE
and HCPCS code J7325
with dates of service on
or after 10/01/10.
Systems changes are
necessary to correct this
issue. The resolution will
be implemented with FISS
PAR R41028S1.
11/08/10-JSM 11001 was
received on November 8,
2010. This issue has been
corrected (added condition
code 15) and released
claims for processing.
No provider action is
required.
Claims are not
01/06/12: FS6537 has been 06/25/12: CMS approved
adjudicating in the FISS scheduled to go into
FS6537 to be closed.
system.
production 6/4/12
E51#U is being worked
manually and there will be
12/8/11: FS6331 closed in no system changes.
error. FS6537 opened with
no scheduled release date. 04/20/12: Work around in
place to manual work
claims until fix is installed
11/23/11: C20114 UF
in June
scheduled to install on
12/5/11.
07/18/11 Update: Cahaba
GBA is manually working
these claims until FISS
installs C20114 UF,
scheduled to be installed
12/5/11. No provider
action is required.
07/07/11 Update: FISS
system maintainer has
scheduled C20114UF to be
installed 12/5/11 to resolve
this issue.
12/15/10 - A resolution is
scheduled to be installed
June 2011 for this reason
code. No provider action
is required.
08/20/10 - Cahaba GBA is
researching and has
contacted CWF to
determine if this reason
code is working properly.
No provider action is
required.
08/05/10
10/1/12
All Part A
When the
The standard system
08/05/10-Systems changes 03/08/11: C201100
Part A Closed/Archived Claims Processing Log
providers
submitting
claims and
adjustments for
mammography
services.
beneficiary
header screen
contains a date
in the
mammography
date field it
prevents
payment.
maintainer (FISS) has
identified a problem
with payment of
mammography claims.
are necessary to correct
this issue. The resolution
will be implemented with
FISS PAR FS6114. The
changes are scheduled for
production in 2011. FISS
PAR FS6114 in March
2011.
installed into production
01-03-11.
Cahaba has begun
adjusting claims.
No provider action is
required.
07/20/10
Part A
providers
Reason Codes: Claims submitted after
07/06/10 are suspending
incorrectly with reason
30723
codes 30723, 31424,
31548 and 31549
31424
31548
07/16/10 The system
maintainer (FISS) is aware
of this and they are
working to correct the
issue. Updates will be
posted as they become
available.
31549
04/12/10
Part A
Providers
Reason Code:
U6806
02/01/10
10/1/12
Rural Health HCPCS code
Clinics (RHC) G0402
09/09/10-Currently waiting 10/13/10- JSM 10443 was
for JSM to be issued by
received on October 4,
CMS.
2010. This issue has been
corrected and the held
No provider action is
claims were released for
requried.
processing
The standard system
maintainer (FISS) has
identified an issue with
Medicare primary
claims receiving reason
code U6806 in error.
This reason code is
being received on
claims for beneficiaries
that do not have a
Medicare Secondary
Payer (MSP) record at
all or an MSP record
that affects the dates of
service.
06/01/10-System changes
are needed to ensure
Medicare primary claims
do not receive this reason
code in error. FISS has
identified an issue and a
resolution will be installed
into the system with the
October 2010 release.
FS5945/C20103UF.
The standard system
maintainer (FISS) has
identified a problem
deductible being applied
in error for HCPCS
code G0402.
09/09/10 Systems changes
are necessary to correct
this issue. The resolution
will be implemented with
FISS PAR FS5903. The
changes are scheduled for
production December 6,
2010.
10/20/10 - This issue has
been corrected and the held
claims for this issue are
being released for
processing.
No provider action is
required.
12/06/10: Release installed
as scheduled.
Providers can submit
adjustments on claims.
Part A Closed/Archived Claims Processing Log
No provider action is
required.
Inpatient
providers
Part A
providers
All provider
submitting
mammogram
charges
10/1/12
U5233-THE
ADMISSION
DATE ON
THIS
INPATIENT
PPS CLAIM
FALLS
WITHIN THE
ENROLLMEN
T PERIOD OF
A RISK HMO.
THIS EDIT
ALSO
APPLIES TO
NON-PPS
INPATIENT,
SNF
INPATIENT,
AND ALL
OUTPATIENT
CLAIMS
WHERE THE
STATEMENT
COVERED
PERIOD
FALLS
WITHIN OR
OVERLAPS
AN
ENROLLMEN
T PERIOD IN
A RISK HMO.
Claims are
being denied
with 39934
incorrectly.
Inpatient HMO tracking
claims have been
denying incorrectly with
this code since
03/04/10.
The informational claims
submitted with Type of
Bill (TOB) 11X and
Condition Code (CC) 04
that denied incorrectly
from 03/04/10 through
5/13/10 are being identified
for adjustment.
08/03/10 - informational
claims that were identified
as incorrectly denied for
U5233 have been reentered and are processed
or in process. Any claims
that denied incorrectly and
were not identified by our
batch process should be reNo action by the providers filed as new claims by the
is required.
provider.
Providers are unable to
adjust claims that
denied with 39934 and
were deemed as
beneficiary liable in
error.
05/03/10- FS5513R1 will
be installed into production
in June 2010. Once the
PAR is installed providers
will be able to adjust
claims.
07/23/10
Adjustment for
mammogram
charges are
being held.
Providers will
see reason code
36440 and
claims are being
held in SM6440
36440- For a woman
over the age of 39,
Medicare will pay for a
screening
mammography
performed after 11 full
months have passed
following the month in
which the last screening
The Centers for Medicare
& Medicaid Services
(CMS) has identified a
Medicare claims
processing issue where
adjustments submitted
against original bills
containing mammography
services are incorrectly
07/14/10
FS5513R1 was installed
into production. Providers
can now adjust their
claims.
Received JSM 10363 on
July 13, 2010. This issue
has been corrected and the
held claims are being
released for processing.
Part A Closed/Archived Claims Processing Log
status location. mammography was
performed.
Note: In order to
determine the 11 month
period, start your count
beginning with the
month after the month
in which a previous
screening
mammography was
performed.
receiving Reason Code
36440 preventing the
claims from finalizing.
Adjustments performed on
claims containing
mammography services
receiving Reason Code
36440 are being held and
will be released on
approximately September
6, 2010, once this claims
processing system issue is
fixed.
We apologize for any
inconvenience you may
experience related to this
issue. A condition code 15
will be added to the claims,
prior to their release, to
apply the appropriate
interest
All Part A SNF Part A Inpatient
providers
SNF no
payment claims
are denying
with Reason
code 19904
incorrectly.
10/1/12
Inpatient SNF no
payment claims
submitted with
Condition Code 21 are
being incorrectly
rejected with Reason
Code 19904 stating that
a qualifying stay is not
present on the claim
(Occurrence Span Code
70).
System changes will be
implemented into the
Fiscal Intermediary Shared
System (FISS) to allow
inpatient SNF no payment
claims submitted with
Condition Code 21 to
process and systematically
bypass Reason Code
19904. These changes will
be installed into production
on June 7, 2010. The
claims that previously
denied incorrectly with
reason code 19904 have
been identified and a mass
adjustment will be entered
to process the claims
correctly. Provider action
will be needed if the
reprocessed claim will
allow the beneficiary to
obtain a new benefit
period. The provider will
need to adjust in sequential
order any subsequent
claims that have been filed.
06/21/10
The system changes have
been installed and claims
affected by this issue have
been mass adjusted.
Part A Closed/Archived Claims Processing Log
Inpatient
providers
Part A
providers
Part A
providers
All providers
Part A
providers that
10/1/12
Cahaba
recognized that
an error was
made when
entering a new
edit into FISS
for inpatient
claims.
Claims
suspended for
51MUE.
The error caused some
August 5, 2010reason
code 31951.
The error was corrected
and affected claims have
been processed.
CWF installed a
release on
October 5, 2009
which removed
the Contractor's
ability to
override reason
code 31953,
39925, V8022,
and V8024.
The claims are looping
between FISS and CWF
as FISS is attempting to
transmit the override
edit and CWF is no
longer accepting the
overrides, preventing
these claims from being
processed.
02/24/10- We are waiting
on responses from FISS
and CWF on how to work
the claims out of the
system. We will post
updates as they are
received.
Reason code
34525 - CLAIM
SUBMITTED
AS
MEDICARE
PRIMARY
AND A
POSITIVE
WORKERS'
COMP
RECORD
EXISTS AT
CWF. THE
CLAIM
SHOULD BE
BILLED TO
THE
WORKERS'
COMP
CARRIER.
A problem has
been identified
Some claims are
denying with 34525
Reason code when an
open Workman's
Compensation record is
found on CWF for the
beneficiary. These
claims do not contain a
diagnosis code related
to the diagnosis listed
on the W/C file.
The system maintainer
(FISS) is aware of this and
they are working to correct
the issue. Updates will be
posted as they become
available.
05/25/10
51MUE is a new FISS 05/04010- R21028R1 will 06/01//10
edit for claims with
be installed in June to
units of service that are correct the problem.
This problem has been
in excess of the
corrected.
medically reasonable
daily allowable
frequency.
03/07/10- The problem has
been corrected and the
claims are being released.
01/22/10- We have
reported the issue and will
post updates as they are
received.
01/25/10
Issue closed with
implementation of
C200946F release.
09/30/09- Status- FISS
continues to work on
resolution (FS5707). An
implementation date for
this resolution has not yet
been determined but will
be updated when more
information becomes
available.
Our print vendor has
01/15/10- The checks from 01/21/10- The problem has
produced the checks but the weeks of January 4th- been corrected and all the
Part A Closed/Archived Claims Processing Log
10/1/12
receive paper
checks
with hardcopy
checks for all of
our Part A
workloads. The
provider
number or NPI
on the checks
are not
matching up
with the
remittance.
has been unable to
generate the remittances
that accompany the
payment.
8th and January 11th-15th, checks have all been
have been printed and the mailed.
matching remittances are
being generated. These
payments will be in the
mail by the first part of the
week of January 18th.
All providers
Reason codes
E2302- THE
SUM OF
UTILIZATION
PLUS
NONUTILIZA
TION DAYS
MUST EQUAL
THE
DIFFERENCE
BETWEEN
THE
THROUGH
DATE MINUS
THE FROM
DATE IN THE
STATEMENT
COVERS
PERIODIF
THE PATIENT
STATUS
CODE IS 30,
OR IF THE
FROM DATE
IS EQUAL TO
THE THROU
DATE, THE
SUM OF
UTILIZATION
DAYS PLUS
NONUTILIZA
TION DAYS
MUST EQUAL
THE
DIFFERENCE
BETWEEN
THE
THROUGH
DATE MINUS
Reason codes E2302
09/30/09- FISS system
and E6103 have been
release C20094UF will be
applying to claims
installed on 12/07/09.
incorrectly.
FISS is aware of this is
August 5, 2010th the
C20094UF release
sometime after October
1, 2009. Any claims that
were submitted
correctly and returned to
the provider can F9
back to Cahaba for
processing and a remark
may be added such as
FS5614/
C20094UF.
12/10/09- The release was
installed on 12/07/09 and
resolved the issue that
caused claims to receive
reason code E2302. These
claims are being worked
by the claims department
and will be released for
processing.
Part A Closed/Archived Claims Processing Log
THE FROM
DATE IN THE
STATEMENT
COVERS
PERIOD, PLUS
1.
**PPS
PROVIDERS DATE OF
ADMISSION
MUST BE THE
SAME AS
FROM DATE.
PLEASE
CORRECT
AND
RESUBMIT/R
EKEY.
HARDCOPY
SUBMITTORS
RESUBMIT
RTP REPORT
WITH
CORRECTION
S. IF THIS IS
AN MSP
CLAIM AND
THE
PRIMARY
PAYER
COVERED
PART OR
August 5,
2010THE
FULL
LENGTH OF
STAY.
& E6103-THIS
INPATIENT
BILL OR
INPATIENT
SNF BILL
CONTAINS
PRIMARY
PAYER
AMOUNTS
(VALUE
CODES 12, 13,
14, 15, 16, 41,
42 AND 43
10/1/12
Part A Closed/Archived Claims Processing Log
All providers
WITH THEIR
ASSOCIATED
AMOUNTS)
WHICH
EQUAL
TOTAL
CHARGES,
BUT
MEDICARE
REIMBURSE
MENT IS
PRESENT OR
UTILIZATION
DAYS ARE
PRESENT.
MSP Liability
ClaimsInvolving
Auto/No-Fault,
and workers'
compensation
claims
Claims submitted as
primary with unrelated
diagnoses codes are
denying or rejecting.
11/17/09- Cahaba is aware
of issues involving MSP
liability claims for Part A
providers. Our systems
area is diligently working
on these issues and has sent
information to the FISS
system maintainer for
assistance. We have made
several callbacks to
providers to obtain claim
examples and will let all
providers know via listserv
when these issues have
been resolved. We will also
update our Claims
Processing Issue Log as
issues are resolved or new
information is available.
12/14/09Cahaba continues to
review claims in
status/location RB7516
and RB7555. Claims that
are indicated as unrelated
in the comments or that
contain diagnosis codes
unrelated to the open MSP
file on CWF are currently
being finalized and
adjusted.
Claims that could
potentially be related to the
open MSP file on CWF
will continue to remain in
status/locations RB7516 or
RB7555.
Claims identified as being
incorrectly denied
(RB9997 status/location finalized claims) for
unrelated diagnoses back
to 07/01/09 will also be
adjusted after the
completion of adjustments
for claims currently in
RB7516 or RB7555.
11/23/09- Claims
previously suspended with
U680D, U680E and
10/1/12
Part A Closed/Archived Claims Processing Log
U680L that were unrelated
to no fault auto, liability or
worker's compensation
have been released for
processing. You may
resubmit your claim if it
was returned and had
unrelated diagnoses. Please
indicate the services were
not related in the remarks
field.
All Providers
Reason Code
U6803 (The
claim has
another payer
identified. The
Intermediary
will research to
confirm or deny
other coverage.)
Many claims are
suspending with this
reason code that have a
MSP (Medicare
Secondary Payer)
record. The system
maintainer (FISS) is
aware of this situation
and they are working on
a resolution.
10/15/09- Claims are
currently being held in
SM5707 status/location.
When FS5707 is installed
into production, a
condition code 15 will be
applied to the claims and
they will be released for
payment.
10/06/09- FISS has
developed a resolution
(FS5707) but an
implementation date has
not yet been given.
Updates will be posted as
they become available.
10/1/12
10/20/09- The Centers for
Medicare and Medicaid
Services (CMS) has
identified a problem where
Medicare Secondary Pay
(MSP) claims are
suspending in error with
Reason Code U6803. We
are holding claims that
receive Reason Code
U6803 until the successful
installation of the software
fix on October 19, 2009.
At that time, we will
release and process the
claims being held. We
apologize for any
inconvenience you may
have experienced related to
this problem.
All Providers
Reason code - Many claims suspended
E46#W with this reason code.
Condition code
'30' and value
code 'A1', 'B1',
OR 'C1' are
present on the
same claim.
10/12/09- The system
maintainer (FISS) is aware
of this situation and has
implemented a resolution.
10/12/09- The claims that
have received this reason
code prior to the
implementation of the
resolution will be worked
by the claims department
and released. These claims
are being worked as a
priority by our claims
department.
13XOutpatient
Hospitals
5169V for AL
Providers,
5010Q for GA
Providers
5000T for TN
Providers
Once the claims are
released we will then turn
the edits back on to begin
the selection process again.
10/06/09- The edits have
been turned back on and
off with an adequate
sample selected. The
providers are asked to
respond to the ADRs
(Additional
Documentation Requests)
Many more claims have
been selected than
intended for these edits.
These edits are selecting
claims for the billing of
CPT 85025, CBC with
differential. Cahaba
5169V, 5010Q GBA is in the process of
Part A Closed/Archived Claims Processing Log
All providers
10/1/12
and 5000T WIDESPREAD
PROBE
REVIEW FOR
CPT 85025
CBC W/
DIFFERENTIA
L
Adjusting
Medicare
Secondary
Payer (MSP)
Claims
releasing these claims.
For some time, the
Fiscal Intermediary
Standard System (FISS)
inadvertently held the
claims in this
status/location beyond
When Medicare the 75 days. As a result,
Secondary
providers were unable
Payer (MSP)
to make adjustment to
claims require the claims.
post-pay
review, they
move to the
status/location
R B7501 or R
B7516 for at
least 75 days.
and the Medical Review
Department will review the
documentation and provide
review results once the
reviews are completed.
The FISS maintainer has
recently provided Cahaba
with a method that will
move claims out of the
post-pay status/location to
the finalized status/location
R B9997. This will allow
providers to submit any
necessary adjustment.
11/23/09- Cahaba is
reviewing claims in
status/locations RB7516
and RB7555. Claims
identified as being denied
incorrectly for unrelated
diagnoses will be adjusted.
Providers can submit
adjustments for claims in
status/location RB9997 for
unrelated diagnoses.
10/01/09- If you have MSP
claims that have been in
status/location R B7501 or
R B7516 for more than 75
days, they should now be
in status/location R B9997,
and you can now submit an
adjustment. If the
adjustment is untimely as a
result of being held in the
post-pay status/location,
submit your adjustment on
a paper claim to the
address listed below, and
include a note explaining
that the claim was held in
the post-pay status/location
past the 75 day
requirement. If the
adjustment is submitted
timely, please submit the
claim electronically. For
information about
timeliness, refer to
the “Time Limitations for
Filing Provider Claims”
section of the Medicare
Claims Processing Manual
(CMS Pub 100-04, Ch. 1,
§70 )
Part A Closed/Archived Claims Processing Log
10/1/12
All providers
Claims on FISS Claim details are not
in status
accurately reflected on
location
remits.
PB9996 with a
paid date of
11/25/08,
11/28/08 or
12/02/08 have
already been
paid. The
payment was
included on the
11/28/08
remittances
even though the
remittance does
not reflect the
claim
detail. Our data
center and the
Part A System
Maintainer are
working on a
fix to move the
paid claims to
the appropriate
status location
of PB9997 and
also generating
a remittance
that will include
the claim detail
for these claims.
Cahaba is working with the
FISS maintainer to
generate correct
remittances.
13XOutpatient
Hospitals
5169V for AL
Providers,
5010Q for GA
Providers
5000T for TN
Providers
Many more claims have
been selected than
intended for these edits.
These edits are selecting
claims for the billing of
CPT 85025, CBC with
differential. Cahaba
5169V, 5010Q GBA is in the process of
and 5000T releasing these claims.
WIDESPREAD
PROBE
REVIEW FOR
CPT 85025
CBC W/
DIFFERENTIA
L
Once the claims are
Claims have been released.
released we will then turn
the edits back on to begin
the selection process again.
All providers
Reason code
A date has not been
These claims are
Claims have moved to
PB9997 and are now on a
remittance dated 12/02/08.
These remittances have
been mailed to the
providers September 24th
& 25th, 2009.
10/29/09- All issues with
Part A Closed/Archived Claims Processing Log
32511 - TYPE
OF BILL IS
EQUAL TO
12X OR 13X,
PRICING
INDICATOR =
Y, HCPC
C9399 IS
PRESENT BUT
ALL NDC
INFORMATIO
N IS NOT
PRESENT.
NDC,
QUANTITY
QUALIFIER
AND
QUANTITY
MUST BE
PRESENT
currently located in
TB9997 status/location.
FISS is working on a
resolution for this issue
and it is being handled
as a priority. The
resolution should allow
the claims to be moved
to SB0100
status/location without
provider intervention. A
date has not been
provided at this point
but this issue will be
updated when additional
information becomes
available.
provided at this point but
this issue will be updated
when additional
information becomes
available.
reason code 32511 have
been resolved. The
external reason code
narrative has been updated
with processing
instructions. Claims
09/30/09-The systems
currently in suspense with
maintainer (FISS)
reason code 32511 need to
continues to work on this be corrected using the
issue. The test cases are
instructions on the reason
currently being worked and code narrative.
an implementation date for
this resolution has not yet
been determined but will
be updated when more
information becomes
available.
*****
OR
*****
All providers
10/1/12
TYPE OF BILL
IS NOT 12X
OR 13X AND
"ALL" NDC
INFORMATIO
N IS NOT
PRESENT. "IF"
NDC
INFORMATIO
N IS
INCLUDED
ON THE
CLAIM THE
NDC,
QUANTITY
QUALIFIER
AND
QUANTITY
MUST BE
PRESENT.
Claims are
When providers hit F9
suspending with to release the claim it
reason code
remains in their status
We have reported this issue The status/location has
to the FISS maintainer and been updated. Providers
will post updates as they
are asked to PF9 claims
Part A Closed/Archived Claims Processing Log
30940 even
location with that reason are received.
back to Cahaba.
though
code instead of
medically
releasing properly.
09/30/09- This issue
denied lines
continues to be researched.
have not been
altered. 30940 WHEN
SUBMITTING
AN
ADJUSTMENT
, PLEASE
NOTE THAT
ANY
MEDICALLY
DENIED
LINES MUST
REMAIN
NONCOVERED.
ADJUSTMENT
S CANNOT BE
MADE TO
LINES
DENIED BY
MEDICAL
REVIEW. AN
APPEAL
REQUEST
MUST BE
SUBMITTED
FOR THESE
LINES.
*
HOWEVER,
YOU MAY
SUBMIT AN
ONLINE
ADJUSTMENT
TO A CLAIM
THAT
INCLUDES
MEDICALLY
DENIED
CHARGES.
*
IF YOU ARE
ATTEMPTING
TO ADD A
LINE, THIS
CAN BE
10/1/12
Part A Closed/Archived Claims Processing Log
DONE AS
LONG AS THE
REVENUE
CODE AND
HCPCS CODE
DOES NOT
MATCH THE
REVENUE
CODE AND
HCPCS OF
ANY DENIED
LINES. IF
THERE ARE
CHARGES
THAT HAVE
BEEN BILLED
IN ERROR,
EXCEPT
THOSE THAT
ARE
MEDICALLY
DENIED, YOU
MAY
REMOVE
THEM. ANY
CHANGE CAN
BE MADE TO
ANY LINE
THAT IS NOT
MEDICALLY
DENIED.
*PRESS F6
FOR
ADDITIONAL
INFORMATIO
N ONCE YOU
REVIEW
YOUR CLAIM,
HAVE
DETERMINED
THAT ALL
MEDICALLY
DENIED
LINES HAVE
REMAINED
NONCOVERED,
AND THAT A
NOTE HAS
BEEN
10/1/12
Part A Closed/Archived Claims Processing Log
INCLUDED IN
REMARKS
EXPLAINING
THE REASON
FOR THE
ADJUSTMENT
10/1/12
All providers
Some claims
are receiving
M5052 reason
code and should
recycle to CWF
every 6 days,
but this is not
occurring in all
situations.
M5052 - THE
BENEFICIAR
Y MASTER
RECORDS
ARE
LOCATED AT
ANOTHER
HOST SITE.
NO
FURTHER
ACTION IS
NEEDED AT
THIS TIME.
Providers may not be
able to determine how
long the affected claims
have been in location
SB90M0-SB90M0.
We have reported this issue
to the FISS maintainer and
will post updates as they
are received.
Direct Data
Entry (DDE)
Providers
An issue in
Direct Data
Entry (DDE) is
allowing low
values to
remain in DCN
positions 15 -16
with an 'X' in
position 17.
The low values are
The system maintainer
preventing claims from (FISS) is working to
processing correctly in a correct the issue.
number of stages of
claims processing.
All providers
ICD-9
procedure code
00.01
(therapeutic
ultrasound of
head and neck)
receiving reason
codes W0564,
W0565,
W0566,
W1467, W1468
or W1469
Cahaba will reprocess any
claims that were denied
incorrectly if they are
brought to our attention.
08/28/09 - The issue has
been resolved with CWF
and the claims should be
processing appropriately.
08/10/09- FISS created a
utility to resolve this issue
and it was implemented
08/10/2009.
07/08/09- ICD-9 procedure
code 00.01 is a valid
procedure and Cahaba
GBA will override this edit
for discharges on or after
October 1, 2008. These
issues will be corrected
with the next version
(V26.0) of the Medicare
Code Editor.
Part A Closed/Archived Claims Processing Log
(MCE has
detected and
ICD-9 error in
the procedure
code).
10/1/12
All providers
Principal
diagnosis code
in the 209.xx
series - The 209
category ICD-9CM was
included in an
edit instruction
to “code first”
another
condition.
However, the
intent of the
code-first
instruction note
was to “code
also” any
condition from
the multiple
endocrine
neoplasia
(MEN) series of
codes (258.01258.03), if the
condition was
present, rather
than mandate
the codes
209.00-209.69
could not be
used as a
principal
diagnoses.
Cahaba will reprocess any
claims that were denied
incorrectly if they are
brought to our attention.
07/08/09 - Cahaba GBA
will override the reason
code W1443 (MCE has
determined that the claim's
principal diagnosis is an
unacceptable diagnosis) if
ICD-9-CM diagnosis codes
209.33-209.69 are present
effective for discharges on
or after October 1, 2008.
These issues will be
corrected with the next
version (V26.0) of the
Medicare Code Editor.
Facilities
billing for
mammography
services
We have
Mammography claims
confirmed that are being incorrectly
some facility
rejected.
claims for
mammograms
are rejecting on
FISS with
U5366 reason,
but are showing
paid on CWF.
However, other
mammogram
06/24/09- FISS and the
data center have been
contacted by Cahaba to
determine the cause of this
issue and a possible
resolution. Please check
our website for future
updates.
02/26/10- The claim
adjustments continue to be
processed. Approximately
30% have been identified
and adjusted at this time.
02/02/10- To verify if the
denial was correct please
check CWF eligibility
system for the next eligible
date of preventive
mammogram services. If
Part A Closed/Archived Claims Processing Log
claims are
denying
correctly with
U5366 reason
code. To verify
if the denial was
correct, please
check CWF
eligibility
system for the
next eligible
date of
preventive
mammogram
services. If the
mammogram
tech date is one
year after the
mammogram
date on your
claim and was
rejected with
U5366, it is
possible that
your claim
denied
incorrectly. If
your
mammogram
services were
rendered prior
to the next
eligible tech
date, the U5366
rejection was
correct.
All Providers
10/1/12
U5600- THE
DATES OF
SERVICE
REPORTED
ON THE
CLAIM
DUPLICATE
THE DATES
OF SERVICE
REPORTED
the mammogram tech date
is one year after the
mammogram date on your
claim and was rejected
with U5366, it is possible
that your claim denied
incorrectly. If your
mammogram services were
rendered prior to the next
eligible tech date, the
U5366 rejection was
correct. Incorrectly denied
claims have been identified
and a small amount of the
claims have been cancelled
in FISS. The claims will be
cancelled with a 13I type
of bill on FISS. They are
presently indicated as
cancelled on the Common
Working File (CWF)
which will require a
cancellation to be
completed in FISS. Once
the cancellation is
completed in FISS, a
correction has to be made
to the CWF removing the
screening HCPC and date.
(CWF has 45 days to
complete this before a 2nd
request can be submitted)
We will submit a new
claim in FISS when the
update has been made on
CWF and the claims
should process
appropriately. We
apologize for any
inconveniences/delays.
Claims are suspending
in the standard system
Cahaba has dedicated
10/01/09- This issue has
resources to working these been resolved- claims have
suspended claims and to
been released and worked.
move them along in the
system. No further action is
required on the provider's
behalf. We anticipate
timely payment of the
claims.
Part A Closed/Archived Claims Processing Log
ON A CLAIM
PREVIOUSLY
PROCESSED
BY THE
INTERMEDIA
RY.
THEREFORE,
NO
MEDICARE
PAYMENT
CAN BE
MADE.
Claims
submitted
within the first
two weeks of
May 2009.
13XOutpatient
Hospitals
521OS Aloxi
13XOutpatient
Hospitals
74XOutpatient
Rehab
Facilities
All Providers
10/1/12
Claims containing
J2469 (Aloxi) and/or
J2353 (Sandostatin)
may have been
processed incorrectly
based on LCDs L27435
and L27437 prior to the
effective date of
09/15/08.
The edits have been
12/10/08
updated. Claims with dates
of service prior to
09/15/2008 will be
identified and adjusted if
effected by either of these
edits.
An error
occurred in the
establishment of
edits 5153V and
5154V
Claims were denied
56900 for insufficient
documentation without
allowing providers an
opportunity to submit
the necessary
documentation for
review.
08/22/08- The claims are 09/09/08
being adjusted to allow for
payment. The edits have
been corrected and the
claim selection process will
begin again.
Edit 5153V has
suspended
claims for CPT
99291 Critical
Care,
Evaluation and
Management of
the Critically Ill
or Injured
Patient, first 30
- 74 minutes,
for TOB 13X.
Due to the FISS
April 7, 2008,
Claims were denied
56900 for insufficient
documentation without
allowing providers an
opportunity to submit
the necessary
documentation for
review.
08/22/08- The claims are 09/09/08
being adjusted to allow for
payment. The edits have
been corrected and the
claim selection process will
begin again.
Causing outstanding
claim ARs under the
04/21/08-The issue has
07/21/08 - Issue resolved
been reported to the system with implementation of
5211S
Sandostatin
Part A Closed/Archived Claims Processing Log
All providers
system release,
claim related
accounts
receivables
(ARs) are not
being offset by
claim payments
and settlement
payments that
are now being
generated under
the
Oscar/National
Provider
Identifier (NPI).
Cahaba has
determined that
when retrieving
archived claims
to perform an
adjustment or
cancel a claim,
the claim that is
being retrieved
does not display
in FISS.
provider's Oscar, which maintainers.
are not being offset by
claim payments and
settlement payments
under the provider's
Oscar/NPI.
C20082UF.
FISS is not retrieving
older claims for
providers to adjust.
Closed
04/21/08- No Update
04/07/08- No Update
01/10/08- This issue has
been reported to the
Enterprise Data Center
(EDC); however, no
timeframe for this issue to
be resolved has been
determined. Cahaba will
provide updated
information as soon as it
becomes available.
01/07/08- No Update
06/11/07- The problem has
been reported. The
resolution is scheduled for
implementation in
December 2007.
Long-Term
Care Hospitals
(LTCHs) and
Inpatient
Psychiatric
Facility (IPFs)
10/1/12
Reason code
37027 applies
to some LTCH
and IRF claims
incorrectly.
Claims with reason code
37027 are suspending in
status/location S
M65EC.
04/07/08- No Update
02/15/08- The issue has
been reported to the system
maintainer. It was
determined that Change
Request 5474 did not
account for claims
submitted with span code
70 dates. A resolution is
scheduled to be
implemented with the April
system release.
04/21/08- This issue was
resolved with the
implementation of the
April system release.
Claims were released from
status/location S M65EC
to continue processing.