Here is a list of current system-related claims processing issues. These issues have been reported to CMS and/or the Fiscal Intermediary Standard System (FISS). Please check here often for updates before contacting the Provider Contact Center. If you still have questions, please Contact Us.
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RHHI Issues
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Provider Types Affected
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Situation
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Impact to Providers
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Status
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| RHHI |
Reason Code U538F is editing incorrectly on adjustment (e.g., 3XG) bill types.
This issue was first reported to FISS and CMS on 03/26/2009. Update on 09/24/2009 - Reason Code U538F is no longer editing incorrectly on adjustment bill types. Providers should continue to check the log for information pertaining to claims currently affected. We are waiting on the FISS maintainer on this fix. |
Adjustments impacted by this situation are currently suspended in SMRADJ or SMU538. Claims are not processing |
03/18/2010 - The fix for this issue is scheduled for the June Release. Providers should continue to check the log for further updates. |
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Joint RHHI and Part A Issues
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Provider Types Affected
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Situation
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Impact to Providers
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Status
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Part A SC, and
RHHI |
On payments dated June 5th through June 12th, some providers experienced delays in claims payments due to FISS claim number assignment issues. This problem was corrected on June 11th. Providers impacted by the issue should have seen payments appear on their remits beginning June 15th. An additional problem has been identified after the installation of the fix on June 11th. Although the payment amount is included on provider checks/EFT's, as well as in the payment amount on the remittance advice, the claim detail is not present on the remittance advice. This is creating a situation where an amount equal to the total reimbursement amount of the missing claims is appearing in the adjust to balance field. It is anticipated that once this issue is corrected, the claim detail will appear on the remittance advice following the date the fix is installed. Since providers have already received payment for these claims, the reimbursement amount for these claims will not be included in the provider’s payment amount on that remittance advice. This will again cause an amount equal to the total reimbursement for these claims to appear in the adjust to balance field on the remit.
This issue was reported on 06/26/2009 and we are currently waiting on the FISS maintainer to evaluate this problem and create a systems fix. |
Providers are receiving payments, however the remittance advice detail will not balance to the payment amount |
03/18/2010 - We are currently working with the Data Center to resolve. |
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North Carolina and South Carolina Part A Issues
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Provider Types Affected
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Situation
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Impact to Providers
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Status
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Part A
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A Fiscal Intermediary Standard System (FISS) issue has been reported – In some claims, all lines are rejected with reason code 39934 and deemed as beneficiary liable in error. Therefore, specific reject reason codes for individual line items are not present in these claims. |
Providers are not able to adjust these claims at this time to determine the 'correct' line item reject reason code. Claims affected may include outpatient claims with inpatient procedures, claims medically reviewed, or MSP claims. |
03/18/2010 - The FISS Data Center has indicated this will be resolved in June 2010. Providers will be able to adjust their claims when the system repair is implemented in June. |