Closed Claims Processing System Issues

https://www.cahabagba.com/part_b/claims/process...

J10 A/B MAC and Title 18 Claims Processing Issue Log Part B Closed/Archived 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.

Date Reported 1/21/11

Provider Types Affected All Part B Providers

Issue or Reason Code HCPCS codes G0438 and G0439

Description Coverage and payment of these codes for a Medicare annual wellness visit (AWV) became effective January 1, 2011 with the implementation of CR 7079. However, claims submitted with these codes were auto-denied beginning 1/1/11 when billed with a routine service diagnosis code.

Update/Work Around/Scheduels Fix 1/26/11: Mass adjustments will be initiated on 1/31/11. No provider action is required.

Resolved 2/9/11: Mass adjustments were completed.

1/14/2011

All Part B providers that are certified to file preventive/screening services.

HCPCS codes for preventive/screening services not subject to deductible.

The deductible is still being applied to some HCPCS codes that are not subject to deductible.

Update 3/23/11: Cahaba has identified these claims. Adjustments have been initiated and claims are being processed. Update 2/10/11: Coinsurance is also being applied incorrectly. All internal testing has been completed and resolutions moved to production 2/10/11. Cahaba is working to identify claims from 1/1/11 to 2/10/11 that need to be adjusted. Corrections are being made to our internal files. Claims will be automatically adjusted. No provider action is required.

4/8/11: All claims identified have been adjusted and applicable deductible and/or coinsurance removed.

All Alabama, Georgia, Tennessee, and Mississippi Clinical Laboratory providers (Specialty 69) All Alabama, Georgia, Tennessee, and Mississippi providers

Clinical Laboratory Claims were inadvertently held beginning June 1, 2010

No claim payments were released from June 1, 2010 through July 8, 2010.

07/13/2010- As of July 13, 2010, all clinical laboratory claims held in error will have been released. No action is needed by the providers.

07/13/2010

Procedure code J9035

Avastin, procedure J9035, is covered for certain cancer diagnosis codes and for certain ophthalmic conditions. We made a system change for DOS 03/01/2010 and after based on an LCD written by Medical Review. We have found that some claims with cancer diagnosis codes are not processing correctly based on these system changes. The claims that are not processing correctly, include a cancer diagnosis code that is approved for Avastin AND a cancer diagnosis code that is NOT approved for this drug. When both a valid and invalid cancer diagnosis are on the same claim, the system is denying the Avastin in error. This was not a scenario we anticipated when testing was performed prior to installing the audits for the LCD. 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.

08/31/2010- System audit was corrected in April. Claims denied in error have been adjusted. 04/05/2010- We are making changes to the system and hope to have the issue resolved soon.

08/31/2010

All Alabama, Georgia, Tennessee, and Mississippi providers

MSP Claims

12/22/2009- Testing and changes have been completed and installed. Claims are now processing correctly. 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. 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.

12/22/2009

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. 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.

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. 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 05/27/2010- All claims have been reprocessed the incorrectly denied as a duplicate. If there are any outlying claims that need to be adjusted, please contact the Clerical Reopening line.

All Alabama, Georgia, Tennessee, and Mississippi providers

Procedure Code G9141

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.

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.

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. 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. 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. 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). 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. 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). 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.

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. 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.

Ambulatory Surgical Centers (ASCs)

Procedure codes 64479, 64480, 64486, or 64484 when billed with 77003, 77012, or 76942.

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.

All Tennessee IDTF providers

Multiple IDTF procedure codes

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

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

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

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

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

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Modiers for Medicare Billing

https://www.cahabagba.com/part_b/education_and...

Modifiers for Medicare Billing

For Medicare purposes, modifiers are two-digit codes appended to procedure codes and/or HCPCS codes, to provide additional information about the billed procedure. In some cases, addition of a modifier may directly affect payment. Below is a list of modifiers including the modifier description and/or instructions and whether the modifier affects the Medicare payment. Ambulance Claim Modifiers Anesthesia Code Modifiers Clinical Research Studies Coronary Angioplasty, Atherectomy and Stent Procedures (CPT codes 92980, 92981, 92982, 92984, 92996) Diagnostic Procedures/Pathology Modifiers End Stage Renal Disease (ESRD) Modifiers Evaluation/Management Code Modifiers Foot Care Modifiers Non-Physician Practitioner Modifier Occupational Therapist Other Modifiers for Medicare Claims Out-patient Hospital/Ambulatory Surgical Center (ASC) Physical Therapist Physician Quality Reporting Initiative (PQRI) Modifiers Positron Emission Tomography (PET) Speech-Language Pathologist Surgical Procedure Expanded Modifiers: Hands-Feet-Eyelids Surgical Procedure Modifiers Teaching Physician Teleconsultations Ambulance Claim Modifiers Modifiers that are used on claims for ambulance services are created by combining two alpha characters. Each alpha character, with the exception of X, represents an origin (source) code or a destination code. The pair of alpha codes creates one modifier. The first position alpha code = origin; the second position alpha code = destination. Origin and destination codes and their descriptions are listed below: D E G H I J N P R S X GM QL QM QN Diagnostic or therapeutic site other than "P" or "H" when these are used as origin codes Residential, domiciliary, custodial facility (other than an 1819 facility) Hospital based dialysis facility (hospital or hospital related) Hospital Site of transfer (e.g., airport or helicopter pad) between modes of ambulance transport Non-hospital based dialysis facility Skilled nursing facility (SNF) (1819 facility) Physician's office (includes HMO non-hospital facility, clinic, etc.) Residence Scene of accident or acute event (Destination code only) Intermediate stop at physician's office in route to the hospital (includes HMO non-hospital facility, clinic, etc.) Multiple patients on one ambulance trip Patient pronounced dead after ambulance called Ambulance service provided under arrangement by a provider of services* Ambulance service furnished directly by a provider of services*

*The QM and QN modifiers are valid for Medicare; however, the services would be denied under Part B Medicare as a Part A Medicare expense. Top Anesthesia Code Modifiers AA AD G8 G9 QK Anesthesia services personally performed by anesthesiologist - Distinct fee schedule amount. Affects payment. Medical supervision by a physician: More than 4 concurrent anesthesia procedures -. Distinct fee schedule amount. Affects payment. Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure Medical direction of 2, 3 or 4 concurrent anesthesia procedures involving qualified individuals - 1999 services limits the payment to 50% of the amount that would have been allowed if personally performed by a physician or non-supervised CRNA. Monitored anesthesia care- No effect on payment. For informational purposes only. Must be used in conjunction with a pricing anesthesia modifier. CRNA service with medical direction by physician- 1999 services limits the payment to 50% of the amount that would have been allowed if personally performed by physician or non-supervised CRNA. Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist. CRNA service without medical direction by a physician - No effect on payment. Payment is equal to the amount that would have been allowed if personally performed by a physician. Unusual anesthesia - Used to report a procedure which usually requires either no anesthesia or local anesthesia; however, because of unusual circumstances must be done under general anesthesia. Coverage /payment will be determined on a "by-report" basis. Anesthesia by surgeon - Used to report regional or general anesthesia provided by the surgeon (Not covered by Medicare).

QS QX

QY QZ

23

47 Top

Clinical Research Studies Q0 (zero) Q1 Top Coronary Angioplasty, Atherectomy and Stent Procedures (CPT codes 92980, 92981, 92982, 92984, 92996) LC LD RC Top Diagnostic Procedures/Laboratory Modifiers GG Diagnostic Mammography - Performance and payment of a screening mammography and diagnostic mammography on same patient, same day. (Moved from other section/alpha order) Left Side - Used to identify procedures performed on the left side of the body. No effect on payment; however, failure to use when appropriate could result in delay or denial (or partial denial) of the claim. Right Side - Used to identify procedures performed on the right side of the body. No effect on payment; however, failure to use when appropriate could result in delay or denial (or partial denial) of the claim. Laboratory Round Trip - No effect on payment Panel test - Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a CPT-recognized panel other than automated profile codes 80002-80019, G0058, G0059, and G0060. No effect on payment- but may assist with medical necessity determinations. CLIA Waived Test - Effective October 1, 1996, all new waived tests are being assigned a CPT code (in lieu of a temporary five-digit G- or Q-code). The CPT code should be billed with a modifier QW by entities holding a Certificate of Waiver. Technical component only - Use to indicate that the technical or professional component is reported separately (from the professional component) for the diagnostic procedure performed. The fee schedule contains different payment amounts for technical components. Affects payment. Portable X-ray Modifiers; two patients Portable X-ray Modifiers; three patients Portable X-ray Modifiers; four patients Portable X-ray Modifiers; five patients Portable X-ray Modifiers; six patients Professional component only - Use to indicate that the physician component is reported separately (from the technical component) for the diagnostic procedure performed. The fee schedule contains different payment amounts for professional components. Affects payment. Reference lab - Used to indicate a lab test sent to a referral (outside) lab, e.g., lab procedure performed by a party other than the treating or reporting laboratory. Note: Referral lab name, address and/or PIN must be included with the claim. No effect on payment. Repeat clinical diagnostic laboratory test - in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. Under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of the modifier -'91'. Note: This modifier may not be used when test are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. This modifier may not be used when other code(s) describe a series of test results (e.g., glucose tolerance test, evocative/suppression testing). This modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. Left circumflex coronary artery Left anterior descending coronary artery Right coronary artery Investigational clinical service provided in a clinical research study that is in an approved clinical research study Routine clinical service provided in a clinical research study that is in an approved clinical research study

LT

RT

LR QP

QW

TC

UN UP UQ UR US 26

90

91

Top End Stage Renal Disease (ESRD) Modifiers AX CB CD CE Item furnished in conjunction with dialysis services. Services ordered by a dialysis facility physician as part of the ESRD beneficiary's dialysis benefit. AMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable AMCC test has been ordered by an ESRD facility or MCP physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity AMCC test has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable Subsequent claims for a defined course of therapy, e.g., EPO, sodium hyaluronate, infliximab Emergency reserve supply (for ESRD benefit only) - No effect on payment. Most recent URR reading of less than 60 Most recent URR reading of 60 to 64.9 Most recent URR reading of 65 to 69.9 Most recent URR reading of 70 to 74.9 Most recent URR reading of 75 or greater ESRD patient for whom less than seven dialysis sessions have been provided in a month

CF EJ EM G1 G2 G3 G4 G5 G6 Top

Evaluation/Management Code Modifiers AI Principal Physician of Record. Used by the admitting or attending physician who oversees the patient's care, as distinct from other physicians who may be furnishing specialty care Unrelated E/M service during a post op period - Use with E/M codes only to indicate that the E/M service was performed during a postoperative period for a reason(s) unrelated to the original procedure. Modifier 24 applies to unrelated E/M services for either MAJOR or MINOR surgical procedure. Failure to use this modifier when appropriate may result in denial of the E/M service. Significant, separately identifiable - Evaluation and Management service by the same physician on the same day as the procedure or other service. The physician may need to indicate that on the day a procedure or service was performed, the patient's condition required a significant, separately identifiable E&M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. The E&M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E&M services on the same date. This circumstance may be reported by adding the modifier -25 to the appropriate level of E&M service. Decision for surgery - Use with E/M codes billed by the surgeon to indicate that the E/M service resulted in the decision for surgery (E/M visit was NOT usual preoperative care).For E/M visits prior to MAJOR surgery (90-day post op period) only. Failure to use this modifier when appropriate may result in denial of the E/M service.

24

25

57

Top Foot Care Modifiers National modifiers were established to allow the class findings to be reported without writing a narrative description. The following modifiers should be used in conjunction with "covered routine" foot care procedures (e.g., 11055, 11056, 11057, 11719) to indicate the severity of the patient's systemic condition. Q7 Q8 Q9 Top Non-Physician Practitioner Modifier One CLASS A finding Two CLASS B findings One CLASS B and two CLASS C findings

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Open Fiscal Intermediary Standard System Claims...

https://www.cahabagba.com/part_a/claims/process...

J10 A/B MAC Claims Processing Issue Log Part A Open Issues
The following list provides you with the most current status of issues affecting processing of claims. Please check here often for updates before contacting the Provider Contact Center with questions.

Date Reported 5/17/11

Providers/Workload Impacted IPF PPS Claims

Issue/Reason Code 38311

Description Claims that the patient is being transferred to another facility that is not part of the same hospital.

Updates/Work Around/Scheduled Fix 6/28/11 Update: The fix for this issue is scheduled to be implemented 7/5/11. This issue has been reported to the system maintainer in question 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.

Resolution Date

5/17/11

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.

6/30/11: FISS has scheduled an implementation date of 7/6/11. 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.

5/17/11

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

6/30/11 Update: FISS has scheduled an implementation date of 7/6/11. 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.

5/17/11

Part A Providers

E461J

Claims with dates of service on and after January 1, 2011, containing surgical procedure codes 10000-69999 with PT modifier are receiving reason code E461J and are being suspended due to deductible incorrectly being applied.

6/30/11: FISS has scheduled an implementation date of 7/6/11. 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.

5/17/11

Part A Providers

Federally Qualified Health Centers (FQHC) claims containing Preventive Service Codes G0402, G0389, Q0091, G0101, G0130, 77078-77081, 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

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.

5/17/11

Part A Providers

Hepatitis B Vaccine Codes 90740-90747

Hospital outpatient claims with dates of 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. Free-standing RDFs claims with dates of service on and after January 1, 2011, containing HCPCS code 90744 are not applying payment on the vaccine code line and are being suspended.

6/30/11 Update: FISS has scheduled CR7012R6 to correct this issue. An implementation date has not been scheduled. Per JSM 11311, the Fiscal Intermediary Shared 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.

5/13/11

Part A Providers submitting roster bills

31596

Roster bills are receiving reason code 31596 in error.

5/13/11: FISS has scheduled PAR CR7234R2 to be implemented with C2011300 release on 7/5/11. FISS PAR CR7234R2 has been written to correct the issue but has not been scheduled for a release. No provider action is required.

1/20/11

All Rural Health Clinic (RHC) Providers

N/A

Coinsurance is being incorrectly calculated.

Update 7/5/11: FISS system maintainer has rescheduled the implementation of PAR FS6217. The new release is C20114UF which has a production date of December 2011. 5/11/11: FS6217- RHC Psych coinsurance fix is scheduled for 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. 4/21/11: 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.

1/5/11

Part A Providers using DDE screens

N/A

Users are unable to key over a specific page number to navigate to another page.

5/9/11: Release 20112UF is scheduled for 6/6/11 to correct this issue. 1/5/11: 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.

12/21/10

Part A Providers

30945

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.

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. 12/15/10 - A resolution is scheduled to be installed June 2011 for this reason code. No provider action is required. 8/20/10 - Cahaba GBA is researching and has contacted CWF to determine if this reason code is working properly No provider action is required

FISS PAR J30043 has been written to correct the issue but has not been scheduled for a release yet.

8/20/10

Part A Providers

E51#U

Claims are not adjudicating in the FISS system.

07/07/10

All Part A providers submitting occupational, physical and/or speech therapy claims

Reason codes: V8022 V8024

The standard system maintainer (FISS) has identified an issue regarding occupational/physical /speech 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.

4/6/11 Cahaba GBA is manually working these claims pending a resolution from FISS system maintainer. No provider action is required. 3/8/11 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. 9/9/10- This has been identified as a CWF issue rather than a FISS issue. FS6090 to correct the V8022/V8024 problem 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)

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