Claims Payment Issues Log


Here is a list of system-related claims payment and processing issues. These issues have been reported to the Centers for Medicare & Medicaid Services (CMS) and/or the Fiscal Intermediary Standard System (FISS). Please check often for updates before contacting the provider contact center. The issues are identified by stand alone articles and will be updated as needed.


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Claims Payment Issues Log Articles


RESOLVED: Home Health Accountable Care Organization (ACO) Reductions Not Recouping Request for Anticipated Payment (RAP) Reimbursement with Reason Code 3719QRESOLVED: Claims Returning for Reason Code C5467 for the Review Choice Demonstration (RCD)RESOLVED: Home Health: Reason Code 38107: Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not MatchRESOLVED: Home Health: Reason Code U5391, Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not MatchRESOLVED: Home Health Reason Code C727E - Home Health PDGM Claims are Suspending Incorrectly with Reason Code C727ERESOLVED: Home Health Reason Code 37253 - Claims Returned to Provider (RTP) Due to OASIS Assessment Not FoundRESOLVED: Home Health: Penalty for Requests for Anticipated Payments (RAPs) Received More Than Five Days EarlyRESOLVED: No Payment Amount on Low Utilization Payment Adjustment (LUPA) Claims with Late Requests for Anticipated Payment (RAP) PenaltiesRESOLVED: Home Health HIPPS Recoding Error Affecting Claims that Span January 1, 2020RESOLVED: Home Health Reason Code W7216 - Requests for Anticipated Payments (RAPs) Returned to Provider (RTP) Incorrectly for an Invalid Line Item DateRESOLVED: Home Health: Low Comorbidity Adjustment for Claims with COVID-19 Diagnosis Code U07.1RESOLVED: Home Health: PCR Duplicate Request RejectionsRESOLVED: Home Health: Penalties for Late Requests for Anticipated Payments (RAPs) Not Being Deducted from Final Reimbursement RESOLVED: Hospice: Payment Rates for Routine Home Care (RHC) on and after January 1, 2016RESOLVED: Sequestration Reduction Applied Incorrectly on April 2021 Dates of ServiceRESOLVED: Hospice Period Dates Not Calculating Correctly on the Common Working File (CWF)RESOLVED: Home Health Reason Codes U524P/U524Q - Some Home Health Final Claims are Cycling in the System for the Timing of the Period/EpisodeRESOLVED: Home Health: Medicare System Not Recoding the Health Insurance Prospective Payment System (HIPPS) Code on Some ClaimsRESOLVED: Hospice Claims Editing for Reason Code U5181RESOLVED: Hospice Notice of Transfer (NOTR) Type of Bill (8XC)RESOLVED: Recoding of Health Insurance Prospective Payment System (HIPPS) Codes from Late to Earlier Periods on Home Health Claims When There Is Separation Between the Periods of Less than 60 DaysRESOLVED: Home Health: Reason Code 37257, Missing or Invalid Federal Information Processing Standards (FIPS) County CodeRESOLVED: Home Health: Payment on Claims When the Requests for Anticipated Payment (RAP) Were Submitted More than 30 Days LateRESOLVED: Home Health: Reason Code 37363 Editing on Low Utilization Payment Adjustment (LUPA) ClaimsRESOLVED: Home Health Pre-Claim Review: Claims Incorrectly Returning for Reason Code 39621Home Health Possible Overpayments on Partial Episode Payments (PEPs) OPEN: Suspension of Outpatient Prospective Payment System (OPPS) Claims Bill Types 12X, 13X, or 34X with COVID-19 Vaccine and Monoclonal Antibodies Services for Medicare Advantage Beneficiaries