Fiscal Intermediary Standard System Claims Processing Issues
The following list provides you with the most current status of claims processing issues that have been reported to the Fiscal Intermediary Standard System (FISS) maintainers and the Centers for Medicare & Medicaid Services (CMS). Please check here often for updates before contacting the Provider Contact Center with questions. Note: Providers do not need to take any action on the claims with the following reason codes.
| Provider Types Affected | Issue / Reason Code | Impact | Status | Resolved |
|---|---|---|---|---|
| Part A providers | HCPCS Code Q0139(Injection, Ferumoxytol, for treatment of iron deficiency anemia 1 mg (for ESRD on dialysis) | 01/29/2010 The Centers for Medicare & Medicaid Services (CMS) has identified a Medicare claims processing issue where claims billed with dates of service January 1, 2010, or later with Healthcare Common Procedure Coding System (HCPCS) Code Q0139 (Injection, Ferumoxytol, for treatment of iron deficiency anemia 1 mg (for ESRD on dialysis)) are being paid based on the billed amount instead of the Medicare fee schedule |
Claims containing HCPCS Q0139 are being held and will be released on approximately March 1, 2010, once this claims processing system issue is fixed. | |
| Part A providers | 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. | 02/24/2010- 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. 01/22/2010- We have reported the issue and will post updates as they are received. |
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| Part A providers that receive paper checks | A problem has been identified 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. | Our print vendor has produced the checks but has been unable to generate the remittances that accompany the payment. | 01/15/2010- The checks from the weeks of January 4th-8th and January 11th-15th, have been printed and the matching remittances are being generated. These payments will be in the mail by the first part of the week of January 18th. | 01/21/2010- The problem has been corrected and all the checks have all been mailed. |
| All providers | MSP Liability Claims- Involving Auto/No-Fault, and workers' compensation claims | Claims submitted as primary with unrelated diagnoses codes are denying or rejecting. | 11/17/2009- 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. | 12/14/2009-
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| 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. | 10/15/2009- 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. 10/06/2009- FISS has developed a resolution (FS5707) but an implementation date has not yet been given. Updates will be posted as they become available. |
10/20/2009- 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 - E46#W - Condition code '30' and value code 'A1', 'B1', OR 'C1' are present on the same claim. | Many claims suspended with this reason code. | 10/12/2009- The system maintainer (FISS) is aware of this situation and has implemented a resolution. | 10/12/2009- 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. |
13X-Outpatient Hospitals |
5169V for AL Providers, 5010Q for GA Providers 5000T for TN Providers
5169V, 5010Q and 5000T - WIDESPREAD PROBE REVIEW FOR CPT 85025 CBC W/ DIFFERENTIAL
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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 GBA is in the process of releasing these claims.
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Once the claims are released we will then turn the edits back on to begin the selection process again.
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10/06/2009- 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) and the Medical Review Department will review the documentation and provide review results once the reviews are completed. |
| All providers | Adjusting Medicare Secondary Payer (MSP) Claims When Medicare Secondary Payer (MSP) claims require post-pay review, they move to the status/location R B7501 or R B7516 for at least 75 days. |
For some time, the Fiscal Intermediary Standard System (FISS) inadvertently held the claims in this status/location beyond the 75 days. As a result, providers were unable to make adjustment to the claims. | 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. | 11/23/2009- 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. 10/01/2009- 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  ) |
| All providers | Reason codes E2302- THE SUM OF UTILIZATION
PLUS NONUTILIZATION 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 NONUTILIZATION DAYS MUST
EQUAL THE DIFFERENCE BETWEEN THE THROUGH DATE MINUS 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/REKEY. HARDCOPY SUBMITTORS RESUBMIT RTP REPORT WITH CORRECTIONS. IF THIS IS AN MSP CLAIM AND THE PRIMARY PAYER COVERED PART OR ALL OF THE DAYS, YOU STILL MUST SUBMIT THE CLAIM WITH THE 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 WITH THEIR ASSOCIATED AMOUNTS) WHICH EQUAL TOTAL CHARGES, BUT MEDICARE REIMBURSEMENT IS PRESENT OR UTILIZATION DAYS ARE PRESENT. |
Reason codes E2302 and E6103 have
been applying to claims incorrectly. FISS is aware of this issue and a correction will be placed into production with 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. |
09/30/2009- FISS
system release C20094UF will be installed on 12/07/2009. |
12/10/2009- The release was installed on 12/07/20009 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. |
| All providers | Claims on FISS in status location PB9996 with a paid date of 11/25/2008, 11/28/2008 or 12/02/2008 have already been paid. The payment was included on the 11/28/2008 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. | Claim details are not accurately reflected on remits. | Cahaba is working with the FISS maintainer to generate correct remittances. | Claims have moved to PB9997 and are now on a remittance dated 120208. These remittances have been mailed to the providers September 24th & 25th, 2009. |
| 13X-Outpatient Hospitals | 5169V for AL Providers, 5010Q for
GA Providers 5000T for TN Providers 5169V, 5010Q and 5000T - WIDESPREAD PROBE REVIEW FOR CPT 85025 CBC W/ DIFFERENTIAL |
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 GBA is in the process of releasing these claims. | Once the claims are released we will then turn the edits back on to begin the selection process again. | Claims have been released. |
| All providers | Reason code 32511 - TYPE OF BILL IS EQUAL TO 12X OR 13X, PRICING INDICATOR = Y, HCPC C9399 IS PRESENT BUT ALL NDC INFORMATION IS NOT PRESENT. NDC, QUANTITY QUALIFIER AND QUANTITY MUST BE PRESENT ***** OR ***** TYPE OF BILL IS NOT 12X OR 13X AND "ALL" NDC INFORMATION IS NOT PRESENT. "IF" NDC INFORMATION IS INCLUDED ON THE CLAIM THE NDC, QUANTITY QUALIFIER AND QUANTITY MUST BE PRESENT. |
These claims are 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. | A date has not been provided at this
point but this issue will be updated when additional information
becomes available. 09/30/2009-The systems maintainer (FISS) continues to work on this issue. The test cases are currently being worked and an implementation date for this resolution has not yet been determined but will be updated when more information becomes available. |
10/29/2009- All issues with reason code 32511 have been resolved. The external reason code narrative has been updated with processing instructions. Claims currently in suspense with reason code 32511 need to be corrected using the instructions on the reason code narrative. 09/10/2009 |
| All providers | 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. |
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. 09/30/2009- 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. |
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| All providers | Claims are suspending with reason
code 30940 even though medically denied lines have not been altered.
30940 - WHEN SUBMITTING AN ADJUSTMENT, PLEASE NOTE THAT ANY MEDICALLY
DENIED LINES MUST REMAIN NON-COVERED. ADJUSTMENTS 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 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 INFORMATION ONCE YOU REVIEW YOUR CLAIM, HAVE DETERMINED THAT ALL MEDICALLY DENIED LINES HAVE REMAINED NON-COVERED, AND THAT A NOTE HAS BEEN INCLUDED IN REMARKS EXPLAINING THE REASON FOR THE ADJUSTMENT |
When providers hit F9 to release the claim it remains in their status location with that reason code instead of releasing properly. | We have reported this issue to the
FISS maintainer and will post updates as they are received. 09/30/2009- This issue continues to be researched. |
The status/location has been updated. Providers are asked to PF9 claims back to Cahaba. |
| 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 BENEFICIARY 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. | 08/28/2009 - The issue has been resolved with CWF and the claims should be processing appropriately. |
| All providers | ICD-9 procedure code 00.01 (therapeutic ultrasound of head and neck) receiving reason codes W0564, W0565, W0566, W1467, W1468 or W1469 (MCE has detected and ICD-9 error in the procedure code). | Cahaba will reprocess any claims that were denied incorrectly if they are brought to our attention. | 07/08/2009- 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. | |
| All providers | Principal diagnosis code in the 209.xx series – The 209 category ICD-9-CM 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 (258.01-258.03), 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. | 07/08/2009 - 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 confirmed that some facility claims for mammograms are rejecting on FISS with U5366 reason, but are showing paid on CWF. However, other mammogram 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. | Mammography claims are being incorrectly rejected. | 06/24/2009- FISS and the datacenter have been contacted by Cahaba to determine the cause of this issue and a possible resolution. Please check our website for future updates. | 02/26/2010- The claim adjustments continue to be processed. Approximately 30% have been identified and adjusted at this time. 02/02/2010- 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. 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. |
| All Providers | U5600- THE DATES OF SERVICE REPORTED
ON THE CLAIM DUPLICATE THE DATES OF SERVICE REPORTED ON A CLAIM PREVIOUSLY PROCESSED BY THE INTERMEDIARY. THEREFORE, NO MEDICARE PAYMENT CAN BE MADE. Claims submitted within the first two weeks of May 2009. |
Claims are suspending in the standard system | Cahaba has dedicated resources to working these suspended claims and to move them along in the system. No further action is required on the provider’s behalf. We anticipate timely payment of the claims. | 10/01/2009- This issue has been resolved- claims have been released and worked. |
| 13X- Outpatient Hospitals | 521OS Aloxi 5211S Sandostatin |
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 09/15/2008. | The edits have been updated. Claims with dates of service prior to 09/15/2008 will be identified and adjusted if effected by either of these edits. | 12/10/2008 |
| 13X- Outpatient Hospitals | 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. | 08/22/2008— The claims are being adjusted to allow for payment. The edits have been corrected and the claim selection process will begin again. | 09/09/2008 |
| 74X- Outpatient Rehab Facilities | 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. | Claims were denied 56900 for insufficient documentation without allowing providers an opportunity to submit the necessary documentation for review. | 08/22/2008— The claims are being adjusted to allow for payment. The edits have been corrected and the claim selection process will begin again. | 09/09/2008 |
| All Providers | Due to the FISS April 7, 2008, 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). | Causing outstanding claim ARs under the provider’s Oscar, which are not being offset by claim payments and settlement payments under the provider’s Oscar/NPI. | 04/21/2008—The issue has been reported to the system maintainers. | |
| Long-Term Care Hospitals (LTCHs) and Inpatient Psychiatric Facility (IPFs) | Reason code 37027 applies to some LTCH and IRF claims incorrectly. | Claims with reason code 37027 are suspending in status/location S M65EC. | 04/07/2008- No Update 02/15/2008- 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. |
04/21/2008- This issue was resolved with the implementation of the April system release. Claims were released from status/location S M65EC to continue processing. |
| All providers | 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. | FISS is not retrieving older claims for providers to adjust. | 04/21/2008- No Update 04/07/2008- No Update 01/10/2008- 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. 01/07/2008- No Update 06/11/2007- The problem has been reported. The resolution is scheduled for implementation in December 2007. |
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| 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 preventing claims from processing correctly in a number of stages of claims processing. | The system maintainer (FISS) is working to correct the issue. | 08/10/2009- FISS created a utility to resolve this issue and it was implemented 08/10/2009. |
Page last March 4, 2010
