January 2020 Quarterly Release Temporary Hold

Each quarter, the Fiscal Intermediary Shared System (FISS) is updated to include new logic for claims processing, pricing, etc.

When the release is installed, Palmetto GBA places a temporary 'hold' to ensure the release is installed properly. During this time, claims with dates of service of January 1, 2020, or later will be held in the status/location listed below and may be released before or on January 14, 2020, to continue processing.

Reason CodeLocation StatusStatus Description
36452 SMHOSP Hospice
37230 SMHOME Home Health Prospective Payment System (PPS) Claims 
 W999 SMFISS Holds All Claims

Home Health RAPs: Hold Starting January 1, 2020

Medicare Administrative Contractors (MACs) typically hold claims for a brief period each quarter when they implement system releases. This January, home health Requests for Anticipated Payment (RAPs) are affected by implementation of the Home Health Patient-Driven Groupings Model. MACs will hold RAPs with From Dates on or after January 1, 2020, and process them once the updates are complete.

Providers should be reminded that Medicare claims processed by the 30th day from claim receipt are considered timely. Beginning on the 31st day from receipt, interest will be applied to claims that have not been processed.

Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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