MCS Claims Processing Issues
The following list provides you with the most current status of claims processing issues. Please check here often for updates before contacting the Provider Contact Center with questions.
If you have been affected by one or more of the issues below and your claims have not been adjusted accordingly please contact the Provider Contact Center. Please note the information in the status column which indicates when the adjustments began or are scheduled to begin.
| Provider Types Affected | Issue or Reason Code | Impact | Status | Resolved |
|---|---|---|---|---|
| All Alabama, Georgia, Tennessee, and Mississippi providers | Procedure codes J0461, J0559, J0586, J0598, J0718, J0833, J0834, J1680, J2562, J2793, J2796, J7185, J7325, J9155, J9171, J9328, Q0138, and Q0139 | Claims submitted between 01/01/2010 and 01/19/2010 with codes J0461, J0559, J0586, J0598, J0718, J0833, J0834, J1680, J2562, J2793, J2796, J7185, J7325, J9155, J9171, J9328, Q0138, Q0139, and number of units greater than one may have incorrectly denied with message, “These are non-covered services because this is not deemed a ‘medical necessity’ to the payer.” | 01/19/2010- The Number of Units field for these codes were updated on 01/19/2010 for all states New claims entering the system 01/20/2010 will not reject for excessive number of units. | 02/01/2010- Any claim containing these codes for 2010 dates of service, submitted after 01/19/2010, will process correctly. Any 2010 rejected injection codes identified by the providers can be resubmitted for payment. |
| All Alabama, Georgia, Tennessee, and Mississippi providers | Procedure Code G9141 | Providers received denials for H1N1 claims received in the system between 12/03/2009 and 12/15/2009. The system read the 01/01/2010 effective date provided by CMS, not the valid 09/01/2009 effective date and claims denied with the message that the code and/or modifier were invalid. | 01/21/2010 - All corrections to the system were made on 12/15/2009. Claims submitted past that date should not experience the problem. No action is needed by the providers. | 01/26/2010- Below is the resolution of impacted claims: AL adjustments completed on 12/22/2009 = 46 providers GA adjustments completed on 01/21/2010= 144 providers MS adjustments completed on 12/30/2009= 54 providers TN adjustments completed on 01/26/2010=202 providers |
| All Alabama, Georgia, Tennessee, and Mississippi providers | Modifiers 76 and 59 | Our current claims processing guides for the proper use of modifier 59 and modifier 76 is based on the article published on the listserv here. However, due to inquiries that have been received regarding this article, Cahaba GBA is researching this issue further to ensure that the billing instructions provided are correct. | 02/19/2010- Cahaba has run a report to identify all claims denied as duplicates with the use of modifier 59. The report is being researched and adjustments will be made to incorrectly denied claims using an automated system. Until the claims have all been adjusted, our Clerical Error Reopening lines will not adjust claims denied as a duplicate appended with modifier 59 to avoid creating overpayments. When all adjustments are completed, an update will be placed on the claims issues log at MCS Claims Processing System Issues and you may again call the Clerical Error Reopening lines to adjust any outlying claims. Cahaba also asks that you do not submit any written redeterminations or Clerical Error Adjustments until you are notified that all adjustments are completed. Thank you for your patience. 12/17/2009- We are researching the issue to provide providers with instructions for the proper usage of both the 59 and 76 modifiers. |
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| All Alabama, Georgia, Tennessee, and Mississippi providers | MSP Claims | Providers are experiencing a delay in the processing of their claims where Medicare is the secondary payer. This delay was caused by an internal problem within our system. | 12/11/2009- We have identified the issue and are currently in the process of testing our changes. We expect to have the changes implemented within the next 10 days. | |
| Ambulatory Surgical Centers (ASCs) | All ASC procedure codes | ASC claims processed between 10/05/2009 and 11/25/2009 may have denied incorrectly with message, "not covered when performed during the same session/date as a previously processed service for the patient," due to a problem created by the MCS system maintainer with the installation of the October 2009 system release. | 11/25/2009- The system maintainer has corrected the problem with the installation of an emergency system release. | 12/10/2009- ASC providers who received the message in question for a service they believe is not included in CCI should re-file the claim(s) for that service. |
Ambulatory Surgical Centers (ASCs) |
Procedure codes 64479, 64480, 64486, or 64484 when billed with 77003, 77012, or 76942. |
The audit for procedure 64479, 64480, 64483 and 64484 being denied when procedure 77003, 77012 or 76942 is not billed has been corrected. The audit was originally set to look for TOS F (ASC facility) for both procedure codes. However, 77003-TC is not a covered service for an ASC facility and the surgical procedure (64479, 64480, 64483 and 64484) were being denied in error. |
10/05/2009- We have updated the system to allow the ASC surgical procedure, if the 77003, 77012, or 76942 has been filed by a physician on the same date of service. |
10/05/2009- We are asking providers to resubmit their claims if they received a denial 107 “The related or qualifying claim/service was not identified on this claim” on the surgical procedure. |
| All Tennessee providers | MSP claims | Tennessee providers are receiving incorrect denials on MSP claims where Medicare should have paid primary due to other insurance no longer in effect. This has occurred because of differences in the way Cahaba and CIGNA Government Services, LLC process claims for secondary insurance. | 09/30/2009- We are currently in the process of making updates to our system. | |
| All Tennessee IDTF providers | Multiple IDTF procedure codes | Tennessee IDTF claims processed on 09/02/2009 may have incorrectly denied with the message, “The rendering provider is not eligible to perform the service billed,” due to the provider file transition from the outgoing TN contractor to Cahaba. | 09/02/2009- The IDTF providers have been verified to be correct in Cahaba's region. | 09/02/2009- The provider files are now correct, so providers are able to resubmit the claims that denied incorrectly. |
| All Alabama, Georgia, and Mississippi providers | Procedure codes 93307, 93320, 93321, 93325, 33508, 96361, 96366, 96367, 96370, 96372, and 96375 | Claims submitted with procedure codes 93307, 93320, 93321, 93325, 33508, 96361, 96366, 96367, 96370, 96372, and 96375 may have been denied incorrectly due to an issue with the audit criteria (audit 292A in AL and 658A in GA and MS). | 3/25/2009- The problem has been corrected and mass adjustments have been scheduled to reprocess the claims that were incorrectly denied. | 4/10/2009- The mass adjustments have been completed. |
| All Georgia providers | Procedure codes 77785, 77786, 93279-93293, 93306, and 95803 | Claims submitted with procedure codes 77785, 77786, 93279-93293, 93306, and 95803 with dates of service from 01/01/2009 to 01/20/2009 may have been denied incorrectly due to the fact that all the pricing components were not built into the system with the January system release. | 1/20/2009- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 1/23/2009- The mass adjustments have been completed. |
| All Alabama, Georgia, and Mississippi providers | Procedure codes 96361, 96366, 96367, 96370, 96372, and 96375 | Claims submitted with procedure codes 96361, 96366, 96367, 96370, 96372, or 96375 may have been denied incorrectly due to an issue with the number of service (edit 190D). | 01/14/2009- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 4/27/2009- The mass adjustments have been completed. |
| All Alabama, Georgia, and Mississippi providers | Legacy qualifiers 1C & 1G | Claims submitted 05/23/2008 and after with legacy qualifiers 1C or 1G are denying with the message, “missing/incomplete/invalid primary identifier” indicating that the billing, rendering, referring, supervising, or facility provider number is invalid. | 07/10/2008- The claims are being denied, because the 1C or 1G qualifier is being used and the system is recognizing it as a legacy number. | 07/10/2007- Please takes steps to ensure that the qualifiers are taken off of all claims prior to submission as well as all legacy numbers. Legacy providers include billing, rendering, referring, supervising, and facility provider numbers as well as UPINs. |
| All Mississippi providers | Procedure codes 95873-95874 | Claims submitted with procedure codes 95873 or 95874 with dates of service between 01/01/2007 and 06/25/2008 may have been incorrectly denied due a problem with the diagnosis codes allowed for these procedures (audit 099A). The allowed diagnosis codes are 3336, 33371, 33372, 33379, 33382-33384, 3430-3439, 37800-37873, and 47875. | 06/25/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 1/14/2009- The mass adjustments have been completed. |
| All Alabama providers | Procedure codes 95873-95874 | Claims submitted with procedure codes 95873 or 95874 with dates of service between 01/01/2007 and 06/25/2008 may have been incorrectly denied due a problem with the diagnosis codes allowed for these procedures (audit 260A). The allowed diagnosis codes are 3336, 33371, 33372, 33379, 33382-33384, 3430-3439, 37800-37873, and 47875. | 06/25/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 1/14/2009- The mass adjustments have been completed. |
| All Alabama, Georgia, and Mississippi providers | Multiple procedure codes | Due to a system maintainer issue with the July 2007 system release several diagnosis and relationship audits were not functioning properly, causing additional payments or overpayments for several providers. | 06/09/2008- The problem has been corrected, affected claims have been identified, and mass adjustments have been scheduled to reprocess those claims correctly. | 1/14/2009- The mass adjustments have been completed for Alabama, Georgia, and Mississippi. |
| All Alabama, Georgia, and Mississippi providers | Procedure code J2323 and chemotherapy administration code 96413 | Claims submitted with procedure code J2323 and chemotherapy administration code 96413 submitted between 04/07/2008 and 06/05/2008 may have been denied due to changes made to J2323's status as an approved drug to be administered using 96413. On 04/07/2008 96413 was removed from coverage for code J2323, but after further review was added back on 06/05/2008. | 06/05/2008- J2323 is once again an approved drug to be administered using 96413. Mass adjustments have been scheduled to reprocess the claims that were denied in error. | 06/12/2008- The mass adjustments have been completed for Alabama, Georgia, and Mississippi. |
| All Alabama providers | Procedure code 77373 | Claims submitted with procedure code 77373 and received between 01/01/2008 and 04/18/2008 may have been incorrectly denied due a problem with the type of service. | 04/18/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 05/05/2008- The mass adjustment has been completed. |
| All Alabama providers | Procedure codes 99341-99345 | Claims submitted with procedure codes 99341-99345 with dates of service between 01/01/2008 and 03/11/2008 may have been incorrectly denied due to a problem with the procedure code. | 04/16/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 05/01/2008- The mass adjustment has been completed. |
| All Alabama providers | All codes | For claims received between 4-1-08 and 4-16-08 the Alabama Medicare Part B system generated payment amounts that were lower than the fee schedule. These incorrect payments affected all codes on the Physician Fee Schedule. The claims can be corrected for this two week period, but the corrections must be processed by provider number, not by procedure code. Please contact the Provider Contact Center to request that your claims be corrected. Provide the Billing and Rendering provider numbers to be corrected, and they will be added to the master list for corrections. | 04/16/2007- The problem has been corrected. | 04/16/2008- Denied claims can be adjusted only if brought to the Carrier's attention. |
| All Georgia providers | Anesthesia procedure codes | Claims received on 03/03/2008 with anesthesia procedure codes may have been incorrectly denied with the message, “The rendering provider is not eligible to perform the service billed” due to an incorrect type of service being assigned to the code (edit 037D). | 04/07/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 04/22/2008- The mass adjustment has been completed. |
| All Georgia and Mississippi providers receiving paper checks and remittances | All | We have experienced a problem with our print vendor for Georgia and Mississippi. The secure connection used to transmit print files is not working. Print cycles for 03/28/2008, 03/31/2008, and 04/01/2008 have been delayed. This is an impact to all providers who receive paper checks and remittances. We have developed a work around to get the files securely printed and mailed. | 04/02/2008- Print files for all three affected dates have been delivered to the print vendor. The files should be printed and mailed by 04/04/2008. | 04/10/2008- The print vendor has finished mailing the backlogged files. |
| All Georgia providers | Multiple procedure codes | Claims submitted with dates of service between 01/01/2007 and 04/10/2008 may have been incorrectly denied due to incorrect claim processing instructions (audit 672A). | 03/31/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 05/21/2008- The mass adjustment has been completed. |
| All Alabama providers | Procedure codes 01935 & 01936 | Claims submitted between the dates of 01/01/2008 and 03/12/2008 with procedure codes 01935 or 01936 may have been incorrectly denied with the message, “The rendering provider is not eligible to perform the service billed” due to an issue with the procedure codes. Claims with multiple units of service were erroneously denied. | 03/26/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 04/16/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure codes 01935 & 01936 | Claims submitted between the dates of 01/01/2008 and 02/19/2008 with procedure codes 01935 or 01936 may have been incorrectly denied with the message, “Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code),” due to an issue with the procedure codes. Claims with multiple units of service were erroneously denied. | 03/26/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 05/15/2008- The mass adjustment has been completed. |
| All Mississippi providers | Procedure code 99214 | Claims submitted between the dates 03/15/2008 and 03/25/2008 of with procedure code 99214 may have incorrectly generated an ADS letter due to an error made by the data center. | 03/25/2008- The problem has been corrected and claims with procedure code 99214 are now being processed correctly. | 03/26/2008- Providers are asked to ignore any ADS letters that were incorrectly generated for procedure code 99214. |
| All Alabama providers | Modifier Q0 | Claims submitted with modifier Q0 between the dates of 01/01/2008 and 03/13/2008 may have been incorrectly denied with the message, “Payment adjusted because this procedure code and modifier were invalid on the date of service,” due to a problem with the modifier. | 03/13/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 04/07/2008- The mass adjustment has been completed. |
| All Mississippi providers | Procedure code Q9967 | Claims submitted with procedure code Q9967 with dates of service between 01/01/2008 and 02/18/2008 may have been incorrectly denied with the message, “Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code),” due to an issue with the procedure code. Claims with multiple units of service were erroneously denied. | 03/12/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/18/2008- The mass adjustment has been completed. |
| All Alabama providers | Procedure code J3488 | Claims submitted with procedure code J3488 with dates of service between 01/01/2008 and 01/30/2008 may have been incorrectly denied with the message, “Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code),” due to an issue with the procedure code. Claims with multiple units of service were erroneously denied. | 03/12/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/28/2008- The mass adjustment has been completed. |
| All providers | Procedure code J1561 | Claims submitted with procedure code J1561 between the dates of 01/01/2008 and 03/10/2008 may have been incorrectly denied due to a problem with the procedure code effective date. | 03/10/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/26/2008- The adjustment has been completed for all affected Alabama providers. 03/14/2008- The mass adjustment has been completed for all affected Georgia providers. 03/13/2008- No affected claims were found for Mississippi providers. |
| All Georgia providers | Procedure code 99219 | Claims submitted with procedure code 99219 with dates of service between 01/01/2008 and 01/08/2008 may have been incorrectly denied with the message, “Payment adjusted because the payer deems the information submitted does not support this many services” due to an issue with the January system release (audit 319A). | 03/04/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 05/13/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure codes 17315 and G0275 | Claims submitted with procedure codes 17315 and G0275 with dates of service between 01/01/2006 and 02/27/2008 may have been incorrectly denied with the message, “Payment adjusted because coverage/program guidelines were not met or were exceeded” (audit 658A). | 02/28/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/03/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code A9579 | Claims submitted with procedure code A9579 with dates of service between 01/01/2008 and 01/29/2008 may have been incorrectly denied with the message, “Payment adjusted because this procedure code and modifier were invalid on the date of service.” | 02/27/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 05/09/2008- The mass adjustment has been completed. |
| All Alabama providers | Multiple procedure codes | Claims submitted with dates of service between 01/01/2006 and 01/08/2008 may have been incorrectly denied with the message, “Payment adjusted because the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated” due to a system problem (audit 481A). | 02/26/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 05/08/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code 71010 | Claims submitted with procedure code 71010 with dates of service between 01/01/2008 and 01/08/2008 may have been incorrectly denied with the message, “These are non-covered services because this is not deemed a ‘medical necessity’ by the payer” due to an issue with the January system release (audit 133A). | 02/25/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 05/05/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code 77418 | Claims submitted with procedure code 77418 with dates of service between 01/01/2008 and 01/08/2008 may have been incorrectly denied with the message, “These are non-covered services because this is not deemed a ‘medical necessity’ by the payer” due to an issue with the January system release (audit 141A). | 02/25/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 05/07/2008- The mass adjustment has been completed. |
| All Mississippi providers | Procedure code 80048 and diagnosis codes 238.71-238.76, 238.79, 995.20 995.27, and 995.29 | Claims submitted with procedure code 80048, diagnosis codes 238.71-238.76, 238.79, 995.20, 995.27, or 995.29 and dates of service between 04/01/2007 and 02/25/2008 may have been incorrectly denied with the message, “These are non-covered services because this is not deemed a ‘medical necessity’ by the payer” (audit 173A). | 02/25/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 02/28/2008- The mass adjustment has been completed. |
| All Alabama providers | Procedure codes 22840-22848 and 22851 | Claims submitted with procedure codes 22840-22848 or 22851 with dates of service between 01/01/2007 and 02/20/2008 may have been incorrectly denied with the message, “Claim/service adjusted because the related or qualifying claim/service was not identified on this claim” (audit 658A). | 2/25/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 02/29/2008- No affected claims were identified; therefore a mass adjustment is unnecessary. |
| All Mississippi and Georgia providers | Procedure codes 22840-22848 and 22851 | Claims submitted with procedure codes 22840-22848 or 22851 with dates of service between 01/01/2007 and 02/20/2008 may have been incorrectly denied with the message, “Payment adjusted because coverage/program guidelines were not met or were exceeded” (audit 658A). | 2/25/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/03/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code 33249, modifier Q0, and diagnosis codes V5332, 4271, 42741, 42742, 4275, 4279, or 99604 | Claims submitted between the dates of 01/01/2008 and 03/13/2008 with procedure code 33249, modifier Q0, and one of the following diagnosis codes: V5332, 4271, 42741, 42742, 4275, 4279, or 99604 may have been incorrectly denied with the message, “Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code),” due to a problem with the modifier (audit 710A). | 02/20/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 05/01/2008- The mass adjustment has been completed. |
| All Mississippi providers | Procedure code 83037 | Claims submitted between 01/01/2008 and 02/20/2008 with procedure code 83037 may have been incorrectly denied with the message, “Payment adjusted because this procedure code and modifier were invalid on the date of service,” due to a pricing error with 83037. | 02/20/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/05/08- The mass adjustment has been completed. |
| All Alabama providers | Procedure code G0275 | Claims submitted with procedure codes 22840-22848 or 22851 with dates of service between 01/01/2007 and 02/20/2008 may have been incorrectly denied with the message, “Claim/service adjusted because the related or qualifying claim/service was not identified on this claim” (audit 658A). | 02/20/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/03/2008- The mass adjustment has been completed. |
| All Alabama providers | Procedure codes 88311-88314 | Claims submitted with procedure codes 88311-88314 between the dates of 01/01/2007 and 12/04/2007 may have been incorrectly denied with the message, “Claim/service adjusted because the related or qualifying claim/service was not identified on this claim” (audit 292A). | 02/20/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 02/28/2008- The mass adjustment has been completed. |
| All Mississippi and Georgia providers | Procedure codes 88311-88314 | Claims submitted with procedure codes 88311-88314 between the dates of 01/01/2007 and 12/04/2007 may have been incorrectly denied with the message, “Claim/service adjusted because the related or qualifying claim/service was not identified on this claim” (audit 658A). | 04/02/2008- Additional claims were found to be affected by this issue, therefore an adjustment has been scheduled. 02/20/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. |
04/08/2008- The additional claims have been adjusted. 02/26/2008- No affected claims were identified; therefore a mass adjustment is unnecessary. |
| All Georgia providers | Procedure code 77414 | Claims submitted with procedure code 77414 and received between 01/01/2008 and 01/08/2008 may have been incorrectly denied with the message, “These are non-covered services because this is not deemed a ‘medical necessity’ by the payer” due to an issue with the January system release (audit 537A). | 02/19/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 04/29/2008- The mass adjustment has been completed. |
| All Georgia providers | All physical therapy procedure codes with modifiers GN, GO, and GP with a place of service 49 | Claims submitted with physical therapy procedure codes, modifiers GN, GO, or GP and place of service 49 with dates of service between 01/01/2006 and 02/11/2008 may have been incorrectly denied. | 02/12/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 04/25/2008- The mass adjustment has been completed. |
| All Georgia providers | Multiple procedure codes | Claims received between 01/01/2008 and 01/08/2008 may have been incorrectly denied with an empty denial message due to an issue with the January system release (audit 275A). | 02/06/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 04/23/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code G0289 | Claims submitted with procedure codes G0289 with dates of service between 01/01/2006 and 02/27/2008 may have been incorrectly denied with the message, “Payment adjusted because coverage/program guidelines were not met or were exceeded” (audit 658A). | 02/06/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/03/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code 36415 | Claims submitted with procedure code 36415 and received between the dates of 01/01/2008 and 02/05/2008 may have been paid incorrectly (at 80%) or mistakenly completely applied to the patient's deductible due to an issue with the January system release. | 02/05/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/20/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code 77421 | Claims submitted with procedure code 77421 and received 01/01/2008 through 01/08/2008 may have been incorrectly denied with the message, “Payment is denied when performed/billed by this type of provider in this type of facility” due to an issue with the January system release (edit 137D). | 02/05/2008- The problem has been corrected and the mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/26/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure codes 99211, 99212, 99213, 99214, and 99215 | Claims submitted with procedure codes 99211, 99212, 99213, 99214, or 99215 and received 01/01/2008 through 01/08/2008 may have been incorrectly denied with the message, “Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this day's supply” due to an issue with the January system release (audit 706A). | 02/05/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 04/02/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code 72192 | Claims submitted with procedure code 72192 and received 01/01/2008 through 01/08/2008 may have been denied incorrectly with an empty denial message due to an issue with the January system release (audit 134A). | 02/05/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/18/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code 64555 | Claims submitted with procedure code 64555 and received 01/01/2008 through 01/08/2008 may have been denied incorrectly with an empty denial message due to an issue with the January system release (audit 102A). | 02/05/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/18/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code Q9967 | Claims submitted with procedure code Q9967 with dates of service between 01/01/2008 and 02/05/2008 may have been incorrectly denied with the message, “Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code)” due to an issue with the January system release. | 02/05/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/14/08- The mass adjustment has been completed. |
| All Georgia providers | Procedure code 99213 | Claims submitted with procedure code 99213 and received from 01/01/2008 through 01/08/2008 may have denied incorrectly due to an issue with the January system release (audit 306A). | 01/30/2008- The issue has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 02/13/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code 70553 | Claims submitted with procedure code 70553 and received 01/01/2008 through 01/08/2008 may have been incorrectly denied with the message, “These are non-covered services because this is not deemed a ‘medical necessity’ by the payer” due to an issue with the January system release (audit 585A). | 01/29/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/07/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code J9303 | Claims submitted with procedure code J9303 and received between 01/01/2008 and 02/01/2008 may have been incorrectly denied with the message, “Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Code or NCPDP Reject Reason Code)” due to an issue with the January system release (edit 359D). | 01/29/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/17/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code 43248 and diagnosis 78720 | Claims submitted with procedure code 43248, diagnosis 78720, and date of service between 10/01/2007 and 02/01/2008 may have been incorrectly denied with the message, “These are non-covered services because this is not deemed a ‘medical necessity’ by the payer” due to an issue with the diagnosis code (audit 631A). | 01/28/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 03/05/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code 84153 | Claims submitted with procedure code 84153 and received 01/01/2008 through 01/08/2008 may have been incorrectly denied with the message, “These are non-covered services because this is not deemed a ‘medical necessity’ by the payer” due to an issue with the January system release (audit 304A). | 01/25/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 02/25/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code J2550 | Claims submitted with procedure code J2550 and received 01/01/2008 through 01/08/2008 may have been incorrectly denied with the message, “These are non-covered services because this is not deemed a ‘medical necessity’ by the payer” due to an issue with the January system release (audit 304A). | 01/25/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. 02/26/2008- It has been found that a mass adjustment is not appropriate for this particular problem. |
02/26/2008- Denied claims will be adjusted if brought to the Carrier's attention. |
| All Georgia providers | Procedure code 83036 | Claims submitted with procedure code 83036 and received 01/01/2008 through 01/08/2008 may have been incorrectly denied with the message, “These are non-covered services because this is not deemed a ‘medical necessity’ by the payer” due to an issue with the January system release (audit 304A). | 01/25/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. 02/26/2008- It has been found that a mass adjustment is not appropriate for this particular problem. |
02/26/2008- Denied claims will be adjusted if brought to the Carrier's attention. |
| All providers | Procedure code G0278 | Claims submitted with procedure code G0278 and received between 01/01/2006 and 02/01/2008 may have been incorrectly denied with the message, “Payment adjusted because coverage/program guidelines were not met or were exceeded” due to an issue with the January system release (audit 658A). Since the date cannot be isolated we are proactively mass adjusting back to 01/01/2006 for claims with procedure code G0278 that hit this audit and denied with the above message. | 01/25/2008- The issue has been corrected and mass adjustments have been scheduled to reprocess those claims that were incorrectly denied. | 03/03/2008- The mass adjustment has been completed for all affected Georgia providers. 02/13/2008- The mass adjustment has been completed for all affected Alabama providers. 02/11/2008- The mass adjustment has been completed for all affected Mississippi providers. |
| All Alabama providers | Procedure code 95874 | Claims submitted with procedure code 95874 and received between 01/01/2008 and 01/08/2008 may have been incorrectly denied due to a problem with the audit (audit 260A). | 01/23/2008- The audit has been corrected and a mass adjustment has been scheduled to correct the problem. | 02/08/2008- The mass adjustment has been completed. |
| All Georgia providers | Procedure code 97110 | Claims submitted with procedure code 97110 and received between 01/01/2008 and 02/01/2008 may have been incorrectly denied with the message, “Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Code or NCPDP Reject Reason Code)” due to an issue with the January system release (audit 547A). | 01/22/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 02/28/2008- The mass adjustment has been completed. |
| All Georgia providers | Multiple procedure codes | Claims received between 01/01/2008 and 01/08/2008 may have been incorrectly denied with an empty denial message due to an issue with the January system release (audit 279A). | 01/17/2008- The problem has been corrected and a mass adjustment has been scheduled to reprocess the claims that were incorrectly denied. | 02/15/2008- The mass adjustment has been fully completed. |
| All Georgia providers | Procedure codes 97035 and 97033 | Claims submitted with procedure codes 97035 or 97033 and received 01/01/2008 through 01/08/2008 may have been incorrectly denied with the message, “These are non-covered services because this is not deemed a ‘medical necessity’ by the payer” due to an issue with the January system release (audit 304A). | 1/16/2008- The issue has been brought to our attention and a mass adjustment has been scheduled to correct the problem. | 02/11/2008- The mass adjustment has been fully completed. 02/08/2008- The first leg of the mass adjustment has been completed. |
| All Georgia providers | Procedure code 50590 (type of service F) | Claims submitted with procedure code 50590 (TOS F) with dates of service between 01/01/2008 and 02/01/2008 were denied incorrectly due to a recent change in CMS policy. | 01/30/2008- The claims that need to be corrected have been identified and a mass adjustment has been scheduled. | 02/04/2008- The mass adjustment has been completed. |
| All providers | Procedure codes 75894, 75896, 75961, 75962, 75964, 75901, 75902 (type of service 6), and 75902 (type of service 1) | Claims with dates of service from 01/01/2007 to 01/23/2008 with procedure codes 75894, 75896, 75961, 75962, 75964, 75901, 75902 (type of service 6), and 75902 (type of service 1) and modifier CB were denied incorrectly. | 1/23/2008- Mass adjustments have been scheduled to correct the claims that were denied in error. | 02/07/2008- The mass adjustment for procedure code (type of service 1) has been completed. 1/31/2008- A mass adjustment has been completed for the following codes: 75894, 75896, 75961, 75962, 75964, 75901, and 75902 (type of service 6). The adjustment for 75902 (type of service 1) has been scheduled. |
| All providers | All | Cahaba GBA, LLC held claims for all 2008 dates of service submitted between 01/02/2008 and 01/11/2008 due to quarterly system changes and pricing updates for the new year. When the claims were released for payment, the high volumes caused a delay in processing at CWF. The primary reason was the application of the 2008 deductible. | 01/25/2007- We have recycled the claims that suspended from CWF and anticipate that this delay will be resolved within the next 10 days. | 02/01/2008- All the affected claims have been released from CWF and will continue through the claims processing system. |
| All Georgia and Mississippi providers receiving paper checks (providers who receive Electronic Remittance Advice and Electronic Funds Transfer were not impacted) | All | An issue has been identified with the January system release. This issue resulted in empty pay remit files being sent to the print center for checks issued between 01/05/2008 and 01/22/2008. | 01/22/2008- The issue has been resolved and we are in the process of resending these remit files to the print center. 01/14/2008- The problem has been identified and is in the process of being remedied. |
01/31/2008- All remittances have now been mailed out by the print center. 01/23/2008- All Mississippi files were received by the print center by close of business January 23, 2008. All checks and remits will be mailed as soon as possible. 01/22/2008- All Georgia files were received by the print center by close of business January 22, 2008. All checks and remits will be mailed as soon as possible. |
| All providers | Procedure codes J0881, J0882, J0885, J0886, and Q4081 (ARA NESP and Procrit) | Claims submitted with procedure codes J0881, J0882, J0885, J0886, or Q4081 with pay dates between 08/23/2007 and 10/19/2007 were erroneously denied. | 11/28/2007- All adjustments have been initiated. 11/01/2007- Adjustments have begun on the effected claims. All adjustments will be initiated no later than 12/07/2007. 10/24/2007- The claims that were incorrectly denied will be adjusted accordingly. |
11/01/2007- Claims with codes J0881, J0882, J0885, J0886, and Q4081 are no longer being incorrectly denied. |
Page last updated: February 19, 2010
