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 |
|---|---|---|---|---|
| Home Health | Claims with reason code E94G3 are in status/location S M90CW. The claims include noncovered charges; however, FISS is applying reimbursement. | Claims are being suspended in order to process as a noncovered with no reimbursement. | 11/5/2008—This issue has been reported to the FISS maintainer. A resolution is scheduled with the January 2009 update to Pricer. | |
Home Health and Hospice Providers |
Providers are experiencing problems with FISS while entering, viewing and correcting claims. |
Claims appear to be missing from the provider’s view even though the claims are processing in FISS. Providers were notified of this issue via an e-mail message on 9/16/2008. |
10/07/2008—No Update 09/25/2008—This issue has been reported to the FISS maintainer. |
11/5/2008—This issue has been resolved. |
Home Health and Hospice Providers |
There is a discrepancy between the pending claim totals that appear on the Claim Count Summary Screen (Option 56), and the claims that display in the Inquiry Menu (Option 12). |
Claims may appear to be suspended
in a specific status/location when they may actually be in
a different status/location. |
10/07/2008—No Update 09/25/2008—This issue has been reported to the FISS maintainer. |
11/5/2008—This issue has been resolved. |
Home Health Providers |
Final claims and system generated adjustments (type of bill 3XG) with dates of service on or after 1/1/2008 that include noncovered charges (e.g., Medicare Secondary Payer) continue to cycle for reason codes U524P and U524Q, which indicate the final or LUPA claim has HIPPS code that is for an early episode and should be a late episode, or it has a HIPPS code that is for a late episode and should be an early episode. |
Claims are suspended in status/location S B1000 and will not continue processing through FISS. |
11/5/2008—A resolution to this issue is scheduled for implementation on Dec. 1, 2008. |
|
Home Health providers. |
CWF is processing claims incorrectly for beneficiaries who have received home health services during 2007, and are in a third or later adjacent episode period. |
Claims are being sent to CWF with the correct episode sequence; however, CWF does not acknowledge beneficiaries’ prior adjacent episode history. As a result, the Health Insurance Prospective Payment System (HIPPS) code changes to an early episode, which causes the claim to be downcoded and be underpaid. |
6/27/2008 — No Update 5/21/2008— 4/21/2008—No Update 4/7/2008—No Update 2/28/2008—This issue has been reported to the system maintainers, CWF, and to the Centers for Medicare & Medicaid Services (CMS). At this time, no action is required by providers. Cahaba will provide updated information as soon as it becomes available. |
11/5/2008—CMS
issued instruction in Change Request 6250. Please
refer to the Medicare Learning Network (MLN) Matters article MM6250 10/07/2008—No Update 09/25/2008—No Update 09/05/2008—No Update 8/18/2008—CMS is still developing instructions. However, providers may initiate adjustments. 7/7/2008—This issue has been resolved. Adjustments will be made once instructions are received from CMS. However, providers may initiate adjustments. |
for
additional information. Page last updated: November 11, 2008
