| Part A Closed Issues |
| Date | Provider Types | Processing Issue | Impact | Status | Resolved |
| 1/18/12 | All | MSP payer line A is not being mapped to the claim on some 50101 claims. | Claims are rejecting with RC 31313 | 3/13/12 Resolved – Reason Code 31313 – Change to the Release of Indicator Field
An issue was previously identified with the “Release of Indicator” field for Institutional Electronic Data Interchange (EDI) claims submitted in version 5010A2. The problem mainly affected electronic claims that were submitted with a primary payer other than Medicare. These claims were auto-populating a value of “N” instead of “Y” or left a blank in the Release of Information (RI) field for the Payer ID field. This caused the Primary Payer Name submitted on the electronic claim not to map to the Fiscal Intermediary Shared System (FISS) claim screen, page 4 (MAP1034), causing claims to Return to Provider (RTP) under Reason Code 31313. A fix was installed in FISS on Monday, March 5, 2012.
2/2/11 Fix scheduled for 3/5/12.
In research- no provider action is necessary
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| 1/18/12 | All | When providers access the beneficiary file in FISS it freezes on page 3 | prevents provider from obtaining eligibility information in FISS | 2/1/12 Fix is scheduled for 2/6/12.
Providers can obtain eligibility information from HIQA or ELGA |
| 11/07/11 | All | LTCH claims are being held for DRG errors | claims are being held in location SMP508 | In research- no provider action is necessary |
| 11/07/11 | All | Claims with DRG 009 and RTC 54 are hitting RC 37002 | claims are being held in location SM65EC | Fix scheduled for January release |
| 11/07/11 | All | OPPS claims hitting RC 32061 in error | claims are rejcting in error | In research- no provider action is necessary |
| 10/17/11 | All | Multiple 3XG's and 8XG's created incorrectly | Claims are being held | 11/7/11 Providers should not try to submit final claims until notified to do so.
In research- No provider action necessary |
| 10/06/11 | All | No deductible/ coins taken on non preventive services for RHC adjustment claims | Adjustments are processing incorrectly | 12/9/11 fix moved to 3/5/12.
10/17/11 Fix scheduled for 12/5/11.
In research- no provider action is necessary |
| 10/06/11 | All | Double Pricing of Revenue Lines for Rural Health Clinic Claims (Bill Type 71X | Rural Health Clinic claims (type of bill [TOB] 71X) with more than one preventive services revenue lines (revenue rode 052X) are double pricing | 1/18/12 Issue resolved, claims released
12/9/11 Fix scheduled for 1/13/12.
11/7/11 claims are being held in location SMP012.
In research- no provider action is necessary |
| 10/06/11 | All | Double Pricing of Revenue Lines for Rural Health Clinic Claims (Bill Type 71X) | Rural Health Clinic claims (type of bill [TOB] 71X) with more than one preventive services revenue lines (Revenue Code 052X) are double pricing | 1/18/12 Issue resolved, claims released 12/9/11 Fix scheduled for 1/13/12. 11/7/11 claims are being held in location SMP012. In research- no provider action is necessary |
| 10/06/11 | All | SNF claims billing rev code AAAXX are hitting edit 31742 for no OC 50 when it is not needed. | Claims are Returning to Provider in error | 10/24/11 claims are being held. Fix scheduled for 11/7/11.
In research- no provider action is necessary |
| 10/06/11 | All | Rural Health Clinic Adjustment Bill Types not taking ded/coins on some non preventive services | Claims are processing incorrectly | 11/7/11 Fix moved to 3/5/12.
Fix scheduled for 12/5/11 |
| 10/06/11 | All | RHC rev code 900 - psych reduction amount is being added twice to patient responsibility | Claims are processing incorrectly | Fix scheduled for 12/5/11 |
| 10/06/11 | All | CWF is counting both the professional bill and outpatient bill towards the 36 visit limit on Cardiac Rehabilitation claims | Cardiac Rehabilitation Claims are rejecting in error | 10/17/11 edit has been turned off.
In research- no provider action is necessary |
| 7/15/11 | All | For bill type 85X HCPCs Q0091, G0101, 77052,77057 and G0202 are calculating coinsurance when they should not be. | Claims are being held in SMP507 | 7/15/11 Fix is scheduled for 8/8/11 |
| 7/15/11 | All | For bill type 85X HCPCs Q0091, G0101, 77052,77057 and G0202 are calculating coinsurance when they should not be. | Claims are being held in SMP507 | 7/15/11 Fix is scheduled for 8/8/11 |
| 7/11/11 | All | Claims for G0438 and G0439 with diagnosis code v70.0 are denying in error | Claims for G0438 and G0439 with diagnosis code v70.0 are denying in error | 8/1/11 Issue has been resolved, providers may resubmit claims.
7/11/11 working to resolve issue. No provider action is necessary. |
| 5/6/11 | All | Claims rejecting incorrectly for Cardiac Rehabilitation Services with Reason Code 39929 | Claims are being held in location SMP539 | 7/11/11 Edits were inactivated- claims are released, no provider action is necessary.
5/16/11 Claims are being held, no provider action is necessary |
| 4/28/11 | All | Services reporting the GA modifier are issuing the incorrect liability when denying. | The remittances are indicating that the provider is responsible, when, in reality, it is the beneficiary. | 7/11/11 Claims are being reprocessed- no provder action is necessary.
4/28/11 Claims will be reprocessed. Please watch for updates. No provider action is necessary. |
| 4/28/11 | All | Co-insurance is applied to reimbursement amount for APCs | Claims are being held | 4/28/11 Claims are in location SMFIND. Release is scheduled for May 9, 2011 |
| 4/28/11 | All | Reason Code 12900 editing incorrectly on SNF, IRF and SB Claims | Claims are RTPing in error | 4/28/11 The fix will be in production on May 9, 2011. No provider action is necessary. |
| 4/28/11 | All | Reason Code 31742 editing incorrectly on SNF, IRF and SB claims with HIPPS Code AAA00 | Claims are suspending to SM7019 | 4/28/11 The fix will be in production on May 9, 2011. No provider action is necessary. |
| 4/28/11 | All | Coinsurance is incorrect on claims with Multiple Procedure Payment Reduction (MPPR) | Coinsurance amounts are over stated for claims containing MPPR | 6/7/11 Mass adjustments completed.
5/4/11 Claims are being held in SMP930- fix is scheduled for production 5/9/11 |
| 4/28/11 | All | HIPPS lines are being resequenced by FISS | Incorrect reimbursement is being made when there are multiple HIPPS lines | 10/17/11 Issue has been corrected. Fix scheduled for 12/5/11. - no provider action is necessary |
| 4/22/11 | All | ESRD claims are suspending for RC 39930 | Claim level coinsurance on ESRD claims is not calculated correctly when modifier AY is billed with drugs subject to consolidated billing | 4/28/11 - The solution will be installed into production on 5/9/11. Claims are being held in location SMFIND. |
| 4/20/11 | All | Claims rejecting C7111 for incorrect patient status 03 | Claims that are coded correctly with Patient Status 03 are rejecting in error | 5/4/11 This issue has been resolved. providers may resubmit their claims.
4/28/11 The solution is currently being tested. If the test is successful, providers will be advised to resubmit their claims. Please watch the ListServ for further instructions. |
| 4/14/11 | All | Hepatitis B Claims Not Reimbursing | Claims that include only Hepatitis B HCPCS codes are suspending on 13X and 72X bill types. If the claims include services other than the Hepatitis B HCPCS codes, they are being processed; however, there is no reimbursement for the Hepatitis B service. | 7/11/11 Fix scheduled for 8/8/11- no provider action is necessary.
04/22/2011: This issue is being researched. Impacted claims are being held in Location SMC838. Please continue to watch the NHIC Web site and our Listserv for future updates. Providers do not need to take any action at this time.
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| 4/14/11 | All | Coinsurance Issue with Outpatient Prospective Payments System Claims | Outpatient Prospective Payment System (OPPS) claims are displaying coinsurance and it is subtracted from the priced amount. | 5/12/11 Mass adjustments were completed, no provider action is necessary.
4/22/11 The fix for this issue is scheduled for May 9th 2011. Please continue to watch the NHIC Web site and our Listserv for future updates.
4/14/11 Impacted claims are being held in Location SMC838. Please continue to watch the NHIC Web site and our Listserv for future updates.Providers do not need to take any action at this time.
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| 4/14/11 | All | Smoking Cessation Claims Rejecting with Reason Code 32383 | Smoking cessation HCPCS codes G0436 and G0437 are rejecting with reason code 32383 when correct diagnosis code is present unless occurrence code 32 is on the claim | 04/14/2011: This issue is being researched. Please continue to watch the NHIC Web site and our Listserv for future updates. Providers do not need to take any action at this time.
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| 4/14/11 | All | Claims Suspending as Duplicates in Error | Since the implementation of the April system release, some claims are incorrectly suspending as duplicates | 4/28/11 Claims have all been released. |
| 4/14/11 | All | Inpatient Rehabilitation Facility Claims Returning to Provider with Reason Code 31595 | IRF claims are being returned to the provider (RTP) with reason code 31595 and are not editing with reason code 31741 as they should be. | 4/28/11 The fix for this issue will be installed into production on 5/9/11. Please watch for updates and instructions on when claims may be resubmitted.
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| 4/14/11 | All | Hospice Notices of Election Rejecting with Reason Code E9351: Please note this is RHHI Only | Hospice notices of election (NOE) transactions require the attending physician and the OTH physician. Since the implementation of the April system release, direct data entry (DDE) is not allowing/capturing the OTH physician NPI; therefore, NOEs are rejecting with reason code E9351. | 6/27/11 Fix scheduled for the 12/5/11 release. Providers should continue to use the work around solution until this fix is in production.
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| 4/5/11 | All | Reason code 11701 occurring on adjustments with an alpha character in the third digit of the type of bill (TOB). | Providers were unable to store their claims | 4/6/11 This RC was turned off in FISS, providers may now enter their claims. |
| 4/5/11 | All | End stage renal disease (ESRD) claims with receipt dates of 04/01/2011 and after were being suspended with reason code 11801. | Provider could not access the Source of Admission field in DDE | 05/18/2011: This issue has been resolved. As of May 9, 2011 the edit was reactivated and claims are now receiving reason code 11801 correctly. As the claims are reviewed, they are being released from status location SMPRZ and are being RTP'd. Providers may correct and resubmit the claims.
4/6/11 This RC was turned off in FISS, providers may now enter their claims. |
| 3/28/11 | All | End Stage Renal Disease (ESRD) claims are rejecting at the claim level rather than the line level. | ESRD claims that include one or more incorrect lines are rejecting at the claim level with the A7 ansi code rather than rejecting appropriately at the line level. | 7/11/11 Fix ix scheduled for 9/6/11 |
| 3/28/11 | All | Providers are inappropriately receiving an A7 ANSI adjustment reason code for an out of balance remit for claims that are fully rejecting with a claim level reason code. | Providers who are impacted by this issue may be seeing discrepancies with ANSI coding on their remittance advice. | 5/4/11 Claims are being held 04/22/2011: The fix for this issue is scheduled for September 6th 2011. Please continue to watch the NHIC Web site and our Listserv for future updates
3/28/11 This issue is currently being researched. Please watch the ListServ updates and this log for future updates. No provider action is needed at ths time. |
| 3/18/11 | All | The Fiscal Intermediary Standard System (FISS) maintainer has identified a system problem with credit adjustment claims related to unsolicited Common Working File (CWF) responses (type of bills ending in ‘G’) which have more than 17 revenue lines. | Payments for these claims are being held up. | 1/20/12 Testing has been successful- moving into production |
| 2/17/11 | All | Some Home Health Claims are pricing incorrectly | Claims are paying incorrectly | 2/17/11 Revised HH pricer received 2/7/11, claims will be mass adjusted. No provider action is necessary. |
| 2/8/11 | All | 2/8/11 Hepatitis vaccines 90708 and 90743 are not reimbursing on type of bill (TOB) 131. | Impacted claims are processing with zero reimbursement for these codes. | 3/14/11 Fix scheduled for April 4th.
2/8/11 This issue is being researched and updates will be communicated as they become available. Providers should not take any action at this time. |
| 2/8/11 | All | Claim files received between midnight on Thursday, 2/3/2011 and 5:00 p.m. ET on Friday, 2/4/2011 received a receipt date of Monday, 2/7/2011 due to an issue with the NHIC Part A EDI Gateway. While many of these files were identified prior to the 2/4/11 cycle and were not processed, there were a number of files that did process in the Friday night claims processing cycle. | Impacted claims were incorrectly returned to the provider (RTP) with reason code 31082 indicating that the receipt date does not match the processing date. | 2/16/11. All claim files with the incorrect receipt date of 02/07/11 have been corrected. No provider action is needed. |
| 2/2/11 | All | Crossover Claims Rejecting with H45138 | Claims crossing over are receiving rejection edit H45138 "Service Facility Name was not expected because the Billing/Pay-to Provider (PRV) is present." This edit indicates that the Taxonomy is present in both the 2000A PRV and the 2310E Loops. This applies to providers with taxonomy codes in both the 2000A PRV and 2310E Loops for all types of bills. | 2/02/11 Providers will need to manually send their rejected crossover claims to the trading partners. Providers will receive a letter/report indicating the claims affected.
Until a fix is installed, providers may discontinue billing a Taxonomy in both the 2310E Loop and 2000A PRV and only include it in one. See CR5243 (R1133CP-MM5243) dated 12/19/06 indicating "Report the service facility locator loop (2310E) in an 837-I claim whenever the service was furnished at an address other than the address reported on the claim for the billing or pay-to provider." |
| 1/12/11 | All | Reason Code 31970- End Stage Renal Disease Claims | Claims are suspending in error | 02/03/2011: This issue is resolved and affected claims have been reprocessed. No provider action is necessary |
| 1/5/11 | All | Provider is unable to enter a page number to advance to another claim page | Providers must tab to desired page | 2/17/11 Fix is scheduled for 6/6/11 |
| 1/5/11 | All | Multiple Procedure Payment Reduction Errors | Therapy claims are processing at incorrect rates | 4/28/11 Claims will be reprocessed when fix goes into production on 5/9/11. No provider action is necessary. |
| 1/5/11 | All | Co-insurance and deductibles are processing incorrectly on Preventative Services claims | Claims are processing incorrectly and are suspended with Reason Code 39930. | 3/14/11 Fix is scheduled for April 4th. Claims are in location SMFIND
02/07/2011 Update: The fix for this issue will not go in tonight as expected. Further research is being conducted and providers will be updated as additional information becomes available. |
| 1/5/11 | All | SNF claims that have a statement through date of 9/30/10 or later are utilizing the 2011 wage index | Causing underpayments on some SNF claims | 2/14 - SNF pricer was installed into production over the weekend. The Hook will be turned off today and claims will be released in the next few days. |
| 1/5/11 | All | Claims that do not have Modifier QQ are hitting for an edit for Modifier QQ | Claims are not processing | 1/11/11 Closed- did not affect claims in production
1/5/11 No action required at this time- additional information will be forthcoming. |
| 1/5/11 | All | Reason Code 34929-this error is generated when doing any claims adjustment stating that inpatient claims must include a valid POA indicator, when it is on the claim. | | 01/24/2011: This issue was successfully resolved on January 20, 2011. For claims on or after January 6, 2011 that were returned to the provider (RTP) as a result of this issue, providers should PF9 to enable processing. Claims that were originally submitted January 3, 4, and 5 will be reprocessed by the contractor upon resolution of an outstanding system issue.
1/20/11 Providers should take no action- additional information will be forthcoming. |
| 1/5/11 | All | Electronic claims (EDI) are entering FISS with the incorrect units on each line. EDI is adding a 0 to the end of units entered by the provider causing the claim in FISS to show incorrect amount of units. | This is causing the claims to either suspend, deny, or RTP depending on the procedure billed. | 2/16/11 As of February 10, 2011 all claims have been corrected. No provider action is needed. |
| 1/5/11 | All | Reason Code 17801 citing an error with diagnosis codes being invalid. | Claims are RTPing or providers are unable to store their claims | 2/16/11 NHIC, Corp. has verified the February 7th fix and have released any claims being held for reason code 17801. |
| 1/5/11 | All | Reason Code 31608 - This error is indicating that there is a condition code 04 on the claim signifying the patient has an HMO. The patient has no HMO and there is no condition code 04 on the claim | Claims are RTPing | 2/16/11 NHIC, Corp. has verified the February 7th fix and have released any claims being held for reason code 31608 |
| 1/5/11 | All | Reason Code 34919 -this error is generated when doing any claims adjustment stating that inpatient claims must include a valid POA indicator, when it is on the claim. | | 02/16/11 CMS has temporarily deactivated reason codes 34919 and 34931, pending system changes by the Fiscal Intermediary Shared System Maintainer. NHIC, Corp. has released claims held for these reason codes. Providers may resubmit any claims that have been returned to them for reason codes 34919 and 34931 for reprocessing.
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| 1/5/11 | All | Reason Code 34931-this error is generated when doing any claims adjustment stating that inpatient claims must include a valid POA indicator, when it is on the claim. | | 02/16/11 CMS has temporarily deactivated reason codes 34919 and 34931, pending system changes by the Fiscal Intermediary Shared System Maintainer. NHIC, Corp. has released claims held for these reason codes. Providers may resubmit any claims that have been returned to them for reason codes 34919 and 34931 for reprocessing.
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| 9/28/10 | All | CR6777 implements a new screen in FISS for providers to view the original OSC that were on the original claim submission | It is only assessable by the provider's primary DDE number | 6/6/11 issue closed.
4/28/11 Testing solution. Work around: the OSCR function can be accessed by using the scroll out function from a claim
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| 8/19/10 | All | The status indicator for CPT Code 90662 is changing from E to L in the October 2010 Integrated Outpatient Code Editor | This affects claims with dates of service on and after December 23, 2009 and before October 1, 2010. | 8/23/10 CMS is instructing contractors to hold claims submitted during this period and to release them for processing after the implementation of the October 2010 IOCE. | |
| 7/19/10 | All | Claims are denying incorrectly with Reason Codes 10702, 31424, and 30723 | Claims are being held in location SMDLTD | 10/6/10 All claims released
9/27/10 FIX going in for October release for reason codes that the July release inadvertently reactivated. Any claims that erroneously suspended with these codes (30723, 31424, 31548, 31549) can be released 10/5/10
8/31/10 Awaiting JSM to be issued from CMS
8.16.10 Claims with RC 31424 and 30723 are still on hold awaiting CMS direction.
8/2/10 Releasing claims with Reason Code 10702, testing reason codes 31424 and 30723 | 10/06/2010 |
| 06/08/2010 | Hosp/SNF | Screening mammography claims receiving reason code 36420 in error | Claims are rejecting in error with RC 36420 indicating bene is under age 35 receiving screening mammography services. | 4/7/10 Claims is manually reviewing and releasing these claims until the system fix is implemented in July 2010. | 06/30/2010 |
| 4/27/10 | All | Claims are denying incorrectly with the 51MUE edit | Claims are being held for correct processing. | 7/11/11 claims are being manually worked. No provider action is necessary.
4/28/11 In research status- claims are being held in location SM2383. No provider action is necessary. |
| 6/10/09 | All | Claim status Issue-some claims for DDE providers are remaining in status location PB9996 | Claims are being paid, however, the claim detail is not printing on the remittance advice nor are the claims finalizing to PB9997. | 10/8/10 Issue Closed
10/4/10 Letters mailed. This issue will be closed.
9/13/10 letter scheduled to be mailed next week.
8/23/10 Remittance Advices have all been reprinted, expect all to be mailed with a cover letter by mid September.
Fix scheduled Feb 1, 2011 | 10/08/2010 |
