MCS Claims Processing Alerts – Archive

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MCS Claims Processing Alerts – Archive

Published on Feb 19 2018, Last Updated on Jan 05 2021

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Jurisdictions: J8B,J5B,Claims,Claims Processing Alerts

Log of resolved system-related claims processing issues.

MCS Claims Processing Alerts

Date Issue Reported	Provider Type Impacted	Description/Claims Coding Impact	Proposed Resolution/Fix/ Action Required	Status	Closed Date
10/13/20	All	Codes 99441, 99442 and 99443, for dates of service 03/01/2020 and after, were added to the list of telehealth codes coverable under the waiver during the COVID-19 PHE. These codes should bypass the Skilled Nursing Facility (SNF) Consolidated Billing (CB) edits.	The system was updated on 11/02/2020 to bypass the SNFCB edits for the codes 99441, 99442 and 99443 for dates of service 03/01/2020 and after. Adjustments have been initiated on the affected claims. No provider action is needed.	Closed	12/28/20
10/05/20	All	An issue has been identified impacting the processing system and the ability to process large electronic claim files.	Shared System Maintainer is working on the fix for this issue. No action is necessary, claims will be brought into the processing system.	Closed	10/08/20
10/01/20	All	CMS revised the Medically Unlikely Edits (MUEs) for CPT codes 86328 and 86769 to MUEs of 3, with MUE Adjudication Indicators (MAIs) of 3, retroactive to July 1, 2020, for implementation in the October 1, 2020, edit files.	The system was updated on October 2, 2020. We will complete adjustments on claims denied for service dates July 1, 2020, thru October 2, 2020. No provider action is needed.	Closed	11/13/20
08/27/20	All	WPS identified an issue where codes 99421, 99422, 99423, 99458, 99473, and 99474 were allowed for routine diagnosis. Services were allowed in error for dates of service 01/01/20 to 08/28/20.	The system was updated on 08/28/20 to deny these codes when billed with a routine diagnosis. Recoupment will occur for services previously allowed for DOS 01/01/20 and after.	Closed	10/02/20
07/27/20	All	During the open comment period for LCD L38213/Article A57630, WPS received concerns related to the denials of claims for medical necessity. Updates have been made based on the LCD L38213 information that indicates, “Coverage will remain available for medically necessary procedures for other conditions not included in this article/LCD.”	The system was updated on July 27, 2020, to allow the services to process for conditions not currently listed in the LCD. This is for codes 22510, 22511, 22512, 22513, 225414, and 22515, and dates of service 12/16/19 and after. We will complete mass adjustments on claims previously denied. No provider action is needed.	Closed	08/11/20
07/24/20	All	WPS identified an issue where code 87631 was being allowed for diagnosis not deemed to be medically necessary and non-covered codes 87632 and 87633 were allowed for dates of service 10/01/19 to present. Related information is in LCD L37764 and Article A57579	The system was updated 07/30/20 to deny code 87631 when not billed with a diagnosis showing medical necessity and recoupment will occur for codes 87632 and 87633 if previously allowed for DOS 10/01/19 and after.	Closed	08/18/20
05/28/20	Specialty 15 – Speech Language Pathologists, Specialty 65 – Physical Therapists, and Specialty 67 – Occupational Therapists	WPS identified an issue where codes G2061, G2062, and G2063 were not being allowed for specialty 15, 65, and 67 providers.	The system was updated on June 4, 2020, to allow G2061, G2062, and G2063 when billed by specialties 15, 65, and 67. We will complete adjustments on claims denied in error. No provider action is needed.	Closed	08/03/20
06/02/20	All	WPS identified an issue where COVID-19 codes G2023, G2024, U0001, U0002, and 87635 were not being allowed for dates of service prior to April 1, 2020.	The system was updated on June 4, 2020, to correct the issue. We will complete adjustments on claims denied in error. No provider action is needed.	Closed	08/03/20
04/20/20	Specialty 41 - Optometrists	WPS identified an issue where codes G2010, G2012, 99441, 99442, and 99443 are not allowed by provider specialty 41 providers.	The system was updated on April 28, 2020, to allow procedure codes G2010, G2012, and 99441-99443 by specialty 41 providers. Adjustments will be completed on any claims denied in error. No provider action is needed.	Closed	08/03/20
04/17/20	Specialties: 62 - Psychologist (Billing Independently, 68 - Clinical Psychologist 80 - Licensed Clinical Social Workers	WPS identified an issue where codes 98966, 98967, and 98968 are not allowed by provider specialties 62, 68, and 80 providers.	The system was updated April 27, 2020, to allow procedure codes 98966-98968 by specialty 62, 68, and 80 providers. Adjustments will be completed on any claims denied in error. No provider action is needed.	Closed	08/03/20
05/19/20	All	On April 28, 2020, the FDA approved an optional increased dose for pembrolizumab (J9271) of 400 mg using an extended dosing interval.	The system was updated on July 1, 2020, to allow up to 400 mg per day for claims with dates of service on or after April 1, 2020. We will complete adjustments on claims denied in error. No provider action is needed.	Closed	08/31/20
07/01/20	All	WPS became aware of an issue resulting in incorrect enrollment eligibility information contained in the Enrollment Database (EDB) used during the claims adjudication process for multiple Railroad Retirement Benefit (RRB) beneficiaries. Claims incorrectly denied for lack of Medicare/RRB eligibility.	On June 1, 2020, the records were updated. We will complete adjustments on claims denied in error. No provider action is needed.	Closed	08/31/20
04/08/20	All	WPS identified an issue with edit 308D. J5 claims and J8 (Michigan only) claims billed in place of service 02 for the COVID-19 pandemic were denying. We updated the edit on April 8, 2020. All claims that denied incorrectly have been reprocessed.	We updated the system on April 8, 2020, to bypass the edit if the place of service billed was 02. Adjustments have been initiated on the affected claims. No provider action is needed.	Closed	08/03/20
10/09/19	All	We have identified an issue regarding beneficiaries with missing entitlement dates. This is causing claims to deny in error. We are temporarily setting these audits to suspend rather than deny claims. The claims will remain in hold until we resolve the issue and can process the claims as expected.	The issue has been resolved and beneficiary records at CWF have been restored as of 10/10/19. Providers should resubmit claims that rejected for the entitlement date if they have verified that the beneficiary was eligible on the date of service.	Closed	01/20/20
10/03/19	All	WPS will hold claims with dates of service on or after 10/01/2019. We will also hold claims for any date of service billed with procedure codes A0427, A0429, or A0433, and a non-payable modifier.	WPS will hold claims with dates of service on or after 10/01/2019. We will also hold claims for any date of service billed with procedure codes A0427, A0429, or A0433, and a non-payable modifier.	Closed	01/14/20
08/23/19	NA	J5 Part B Medicare Summary Notices (MSN) for Nebraska beneficiaries are printing with the Kansas Contractor Number 05202, on Page 2 under the “How to Get Help with Your Questions” section, instead of the Nebraska Contractor Number 05402. The MSNs are also printing the Kansas PO Box number 7238 in the “File an Appeal in Writing” Section of Page 4 instead of the Nebraska PO Box 8667. This started occurring after a mid-July update.	Although we realize this only impacts the communication sent to the beneficiaries, we wanted to make providers aware of this issue in the event you receive any questions from Medicare beneficiaries. Correspondence sent to either address will be handled appropriately.	Closed	10/04/19
06/20/19	All	We incorrectly priced procedure code A9513, Lutetium LU 177 1 millicurie, on claims processed 02/14/19 through 06/19/19. The correct fee is $278.73.	We are reprocessing claims with the correct fee. No provider action is needed.	Closed	07/12/19
06/19/19	All	There was an issue during the transmission of some Optical Character Recognition claims to the shared processing system. The diagnosis pointers did not map to the detail so the header diagnosis was not mapped to the details for claims processed 06/17/19, 06/19/19.	J5 claims suspended for manual review and correction. The provider requires no action. J8 MI claims suspended for manual review and correction. The provider requires no action. J8 IN claims denied. Providers may resubmit claims.	Closed	07/12/19
05/23/19	All	Some J5 Part B electronic claims with a receipt date of 04/25/19 did not enter into the MCS processing system when providers submitted them.	We brought the claims into the MCS system on 05/23/19.	Closed	06/24/19
04/01/19	All ACO model participants	The Next Generation ACO Model team recently identified an error in the provider files used to instruct the MACs to reduce claim payment amounts by a specified percentage under the All-Inclusive Population Based Payment (AIPBP) and Population Based Payment (PBP) payment mechanisms tested in NGACO. This resulted in incorrect payments (no reduction applied to the claim) for providers in the Next Generation ACO Model.	The NGACO team sent a corrected provider file to Shared Systems, which now classifies all of the previously missing providers as participating in PBP/AIPBP. Claims began processing correctly with the reductions on 03/25/19; however, this will trigger significant reprocessing and issuing of demand letters beginning in the next couple of weeks.	Closed	06/24/19
03/06/19	All	WPS GHA has identified an issue with 01/01/19 coding changes for psychological testing (CPT codes 96105, 96112-96125 and 96130-96146). These services were previously paid in one-hour increments, but some of the new codes are now in 30-minute increments. Because the MCS system could not be coded to auto-calculate for the time differences, claims which were billed for less than eight hours per year were incorrectly denied as more than eight hours total.	The system was updated on 03/15/19 to manually calculate any claims which exceed the 8 hours limit on editing. Adjustments will be initiated on the affected claims. No provider action is needed.	Closed	06/24/19
03/06/19	All	New CPT codes 99451, 99452 and 99491 were added to initial E/M code auditing but can be used as subsequent E/M codes.	These codes were removed from the initial E/M code auditing on 03/13/19. Adjustments will be initiated on the affected claims. No provider action is needed.	Closed	06/24/19
03/08/19	All	Editing for inactive or invalid facility provider NPIs for anti-mark-up or reference lab services has been temporarily disabled.	Claims you believe were incorrectly returned as denied, with standard code 16, may be resubmitted.	Closed	06/24/19
03/04/19	All	A system edit denied a small amount of claims for Mohs Surgery with no Separate Excision.	WPS GHA will reprocess the impacted claims.	Closed	06/24/19
02/14/19	All	An issue was found with the MIPS (Merit Based Incentive Payment System) adjustment process and adjustments were being applied to procedure codes that should not have been adjusted.	A correction is being made and if any of your claims were incorrectly adjusted, you will be notified.	Closed	06/24/19
02/08/19	Clinical Psychologists	New CPT codes 96112, 96113, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139 and 96146 were not set up as payable with provider type Clinical Psychologists.	The system was updated on 02/11/19 to allow these codes by clinical psychologists. Adjustments will be initiated on the affected claims. No provider action is needed.	Closed	03/26/19
02/08/19	All	Claims with Procedure code A9500 processed 04/01/18 through 02/05/19, with a date of service 04/01/18 and after, allowed the incorrect amount. On 04/01/18, procedure code A9500 was updated with the incorrect amount of $474.00. The correct allowed amount is $450.30. Resulting in an overpayment for procedure code A9500 of $23.70 on claims processed 04/01/18 through 12/27/18, with a date of service 04/01/18 and after.	Adjustments will be initiated on claims processed with the incorrect amount. Providers will be notified of any overpayments they received.	Closed	06/24/19
01/29/19	All	Some anesthesia claims for 2018 dates of service were incorrectly denied for Part B skilled nursing facility consolidated billing: HCPCS codes 00731, 00732, 00811, 00812, and 00813. Claims for these services will automatically be reprocessed by Medicare Administrative Contractors and adjustments will be performed. You do not need to do anything.	Adjustments will be initiated on the affected claims. No provider action is needed.	Closed	06/24/19
01/22/19	All	A system edit was turned off that was rejecting and denying claims for certain Extracranial Doppler Imaging service. The claims that were affected will be reprocessed by the MAC.	Adjustments will be initiated on the affected claims. No provider action is needed.	Closed	06/24/19
12/27/18	All	Claims with Procedure code A9606 processed 04/01/18 through 12/27/18 allowed the incorrect amount. On 04/01/18 procedure code A9606 was updated with the incorrect amount of $153.31. The correct allowed amount is $150.31. Resulting in an overpayment for procedure code A9606 on claims process 04/01/18 through 12/27/18.	Adjustments will be initiated on claims with procedure code A9606 processed 04/01/18 through 12/27/18 to identify the overpayments. Providers will be notified of any overpayments they may have received.	Closed	01/22/19
12/28/18	All	Due to the MCS January Release being installed into the contractor’s system on January 7, 2019, WPS GHA will be holding claims with dates of service 01/01/19 and after with a receipt date of 01/01/19 and after.	No Provider action required. Once the release has been installed and verified WPS GHA will start releasing those claims into the system for processing.	Closed	01/22/19
11/02/18	All	J0881 and J0885 LCD L34633 for DOS 10/01/18 and after group 8 diagnosis codes were erroneously denied. Diagnosis codes denied are: C93.10, C93.11, D46.0, D46.1, D46.20, D46.21, D46.22, D46.A, D46.B, D46.C, D46.4, D46.Z, D46.9, Z79.899. We apologize for any inconvenience this has caused.	A mass adjustment will be done to correct the impacted claims/adjustments. Adjustments will be initiated within the next 30 days. You do not need to take any action	Closed	06/24/19
08/22/18	All	For claims processed 07/01/18 – 08/28/18. CMS revised the MUE file for procedure codes J7345 & J2182.	Claims will be automatically adjudicated. No provider action is necessary.	Closed	01/22/19
07/19/18	All	For claims processed 07/02/18 – 07/19/18, any DOS, codes 77065-26, 77066-26, and 77067-26 may have been denied incorrectly indicating “This facility is not certified for digital mammography.” The incorrect denials are being reprocessed so payment can be made to the providers.	WPS GHA is in the process of reprocessing the claims denied in error. No provider action is necessary.	Closed	01/22/19
04/04/18	All	The Bipartisan Budget Act of 2018 contains a number of provisions that extend certain Medicare FFS policies, including Ambulance add-on payment provisions, the Work Geographic Practice Cost Index (GPCI) Floor, and the three percent Home Health (HH) Rural Add-on Payment. In addition, the Act permanently repeals the outpatient therapy caps beginning on January 1, 2018, while retaining the requirement to submit the KX modifier for services in excess of the prior cap amounts. Due to the retroactive effective dates of these provisions, your MAC will reprocess various Medicare FFS claims impacted by this legislation. For more information see MM10531 .	WPS GHA is in the process of reprocessing claims impacted by this legislation. No provider action is needed.	Closed	01/22/19
07/06/18	All	NCD 110.23 for Stem Cell Transplantation has separate criteria for code 38240 in a clinical trial; when submitted with modifier Q0	WPS GHA is reprocessing claim which were processed 02/06/17 and after which did not have the correct diagnosis criteria applied for code 38240-Q0.	Closed	06/24/19
11/13/18	All	G0452/26 MolDX guidelines have been updated to no longer require a Z ID for the MolDX code G0452 for dates of service 09/28/2017 and after.	Claims for code G0452/26 that were rejected due to no Z ID being billed will be automatically reprocessed. No provider action is necessary.	Closed	01/22/19
09/18/18	All	An edit was added to the system to deny codes 63663, 63685, 63688, 64553, 64555, 64561, 64566, 64585 and 64590 when billed in place of service (POS) 11. It was determined these codes could be allowed in POS 11. These codes were removed from this edit on 09/26/18.	Claims for codes 63663, 63685, 63688, 64553, 64555, 64561, 64566, 64585 and 64590 that denied because the POS was 11 will be automatically reprocessed. No provider action is necessary.	Closed	01/22/19
09/12/18	All	Place of service (POS) 11 was removed as payable from kyphoplasty codes 22513, 22514 and 22515. On 09/13/18 POS 11 was added back as payable to codes 22513, 22514 and 22515.	Claims for codes 22513-22515 that denied because the POS was 11 will be automatically reprocessed. No provider action is necessary.	Closed	01/22/19
06/15/18	All	On 10/02/17, CMS Change Request (CR) 9911 revised the Medicare Remittance Advice (RA) for Qualified Medicare Beneficiary (QMB) claims to identify QMB patients and reflect zero cost-sharing liability. This change resulted in unanticipated issues for providers, states and other secondary payers who are used to seeing Medicare deductible and coinsurance amounts in specific fields on the RA. For more information see MM10494 .	WPS GHA initiated adjustments for QMB claims with dates of service prior to 12/07/17 that received the QMB messages implemented on 10/02/17. No provider action is necessary.	Closed	07/13/18
04/02/18	All	NCD220.4 adds ICD-10 diagnoses N63.11-N63.14, N63.21-N63.24, N63.31, N63.32, N63.41, N63.42 effective 10/1/17. They replace truncated ICD-10 diagnosis N63 that was end-dated effective September 30, 2017. It also end-dates procedure codes G0202, G0204, and G0206 effective December 31, 2017, and replaces them with procedure codes 77067, 77066, and 77065 effective January 1, 2018. NCD220.13 also adds ICD-10 diagnoses N63.11-N63.14, N63.21-N63.24, N63.31, N63.32, N63.41, N63.42 effective 10/1/17. They again replace truncated ICD-10 diagnosis N63 that was end-dated effective September 30, 2017. Since the new ICD-10 diagnoses codes were effective October 1, 2017 and were not included in the shared system edits until April 2, 2018, claims associated with the above-noted two NCDs may have been denied in error	WPS GHA is in the process of reprocessing the claims denied in error. No provider action is necessary.	Closed	04/04/18
03/29/18	All	Radiation therapy codes denied as being included in Skilled Nursing Facility (SNF) Consolidated Billing (CB). Affected codes: 77770, 77771, 77772 Each of these codes are required to appear on CWF Files 1 and 2. For 2016 and 2017, none of the codes appear on File 1, but they are all on File 2. For 2018, 77770 and 77771 are on both files, but 77772 is only on File 1. Visit CMS SNF CB webpage for the Files.	WPS GHA has been instructed by CMS to apply the SNF CB override to these codes to adjust the claims when brought to their attention, for claims with dates of service on or after January 1, 2015. This bypass will be used until the SNF CB quarterly update in October. Providers that have already received payment from the SNF for these codes will need to return that payment to the SNF to receive payment from WPS GHA.	Closed	04/06/18
02/27/18	All	Some claims/adjustments for ambulance services to and from dialysis facilities and/or physician services billed with modifier 26 were denied in error. These erroneous denials have resulted in providers receiving overpayment demand letters.	The issue was resolved on February 27, 2018. WPS GHA is waiting for direction from Centers for Medicare & Medicaid Services (CMS) regarding directions for reprocessing impacted claims. No Provider Action needed.	Closed	04/13/18
08/17/18	All	EKG Services A system edit has been turned off that was rejecting and denying claims for certain electrocardiographic services. Affected claims will be reprocessed by the MAC. If you have questions, please contact your MAC provider contact center.	No provider action necessary.	Closed	08/17/18
03/16/18	All	We are currently having an issue with our file transfers on March 12-14, 2018, to the CMS Virtual Data Center. As a result, some EMC files have not been loaded into the MCS system. We are diligently working on a resolution. The outstanding files will be submitted with the correct receipt date. Providers do not have to resubmit the files. We will update the status on March 19, 2018. 03/19/18 Update: The J5B and J8B transfers are resolved and claims are in MCS.	There is no action needed by the provider	Closed	03/19/18
01/30/18	Portable X-ray Suppliers	WPS GHA has denied X-ray codes 71045-71048, 74018, 74019, and 74021 which are effective 01/01/18 and after when provided by portable x-ray suppliers. In addition, transportation of portable x-ray equipment and set-up of portable x-ray equipment codes R0070, R0075, and Q0092 are being denied when submitted with the above x-ray codes.	A mass adjustment has been requested for any claims negatively impacted by this issue. The issue was corrected on 02/02/18. There is no action needed by the provider.	Closed	02/19/18
01/23/18	All	National Coverage Decision (NCD) 40.7 indicates there are MAC-controlled discretionary edits to allow coverage of 94681 used outside of Outpatient Intravenous Insulin Treatment (OPIVIT), to be determined by MACs. WPS GHA has determined that 94681 can be covered when used outside of OPIVIT. The system was updated on 01/25/18 to allow this situation.	Reopenings have been completed for code 94681 that were previously denied based on NCD 40.7 to allow when used outside of OPIVIT. This is for services originally processed 7/14/17 and after. There is no action needed by the provider	Closed	02/09/18
01/23/18	All	Effective for dates of service on or after 01/18/17, claims processed 01/02/18 and after, with procedure code 0387T, 0389T, 0390T & 0391T are denying when ICD-10- Z00.6 is not propagating down to the procedure code level. The system maintainer has developed a fix for the problem and will be installing it into the processing system. WPS GHA has developed a workaround to suspend the claims for manual review until the fix is put in place.	Claims that have denied in error will be reprocessed after the fix is installed. There is no action needed by the provider.	Closed	02/08/18
11/17/17	All	Some of the paper claims received on 11/14/17 experienced an issue with DX pointer due to a system issue. This issue was corrected on 11/15/17.	Any claims negatively impacted by this issue will be adjusted. There is no action needed by the provider.	Closed	11/22/17
10/26/17	All	From 9/14/17-10/27/17 CPT codes 37223 and 37225 were denied when performed in POS 11. This was corrected on 10/27/17.	A mass adjustment has been requested for CPT codes 37223 and 37225 that might have denied in POS 11. There is no action needed by the provider.	Closed	11/02/17
10/17/17	All	The article Chemotherapy Agents for Non-Oncologic Conditions (A55639) describes coverage of chemotherapy agents A9606, J9070, J9151, J9165, J9190, J9215, J9250, J9260, J9270, J9310, and Q2017 for non-cancer conditions. An audit was set to deny chemotherapy drugs with the intent to deny the non-covered, non-oncologic uses for dates of service 09/16/17 and after. However, claims for oncological uses may have denied in error. This audit was corrected on 10/20/17.	A mass adjustment has been requested for any of these HCPCS codes which might have denied based off this article that might contain a chemotherapy diagnosis. There is no action needed by the provider.	Closed	11/10/17
10/06/17	All	Local Coverage Decision (LCD) L34741 (INJ-041). Additional diagnosis codes were added as payable for HCPCS J0178 and J2778 for dates of service 04/15/17 and after. These were added to the system on 10/16/17. Please see the LCD update for a listing of the diagnosis codes added as payable.	A mass adjustment has been requested for any claim that might have denied with one of these diagnosis codes. There is no action needed by the provider.	Closed	10/28/17

global-tags: J8B,J5B,Claims,Claims Processing Alerts

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MCS Claims Processing Alerts – Archive

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NPI_MODAL_PART_B_TITLE	NPI_MODAL_PART_A_TITLE
J5B RADIO NPI_MODAL_J5B_RADIO	J5A RADIO NPI_MODAL_J5A_RADIO
INB NPI_MODAL_INB_RADIO	NTA NPI_MODAL_NTA_RADIO
MIB NPI_MODAL_MIB_RADIO	INA NPI_MODAL_INA_RADIO
	MIA NPI_MODAL_MIA_RADIO