Claims Processing Issues Log

Here is a list of current 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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Latest Articles


Claims Returning for Reason Code C5467 for the Review Choice Demonstration (RCD) 06/05/2020
RESOLVED: Additional Documentation Requests (ADRs) Issued in Error for Pre-Claim Review Home Health Agencies 05/21/2020
PECOS Document Upload and Retrieval Issue 04/30/2020
Home Health HIPPS Recoding Error Affecting Claims that Span January 1, 2020 04/28/2020
RESOLVED: Service Intensity Add-On (SIA) Payment Is Not Applying to Some Adjustments 04/24/2020
Hospice Payment Rates for Routine Home Care (RHC) on and after January 1, 2016 04/23/2020
RESOLVED: iQIES File Issue Causes Claims to RTP with Reason Code 37253 04/10/2020
Home Health Reason Code C727E - Home Health PDGM Claims are Suspending Incorrectly with Reason Code C727E 03/26/2020
Home Health Reason Code U5387 - Patient Still on Service, but the Final Claim's Dates of Service Don't Equal a 30-Day Period Timeframe 03/26/2020
Home Health Reason Codes U524P/U524Q - Some Home Health Final Claims are Cycling in the System for the Timing of the Period/Episode 03/26/2020
Hospice Claims Editing for Reason Code U5181 03/26/2020
Hospice Notice of Transfer (NOTR), Type of Bill (8XC) 03/26/2020
Home Health Patient-Driven Groupings Model (PDGM) Claims HIPPS Codes are Being Recoded Incorrectly 03/24/2020
Hospice Period Dates Not Calculating Correctly on the Common Working File (CWF) 09/26/2019
Home Health Medicare Secondary Payer Claims are Being Overpaid 06/27/2019
Recoding Health Insurance Prospective Payment System (HIPPS) Codes Through a Review Process 09/12/2017

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