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Let’s Chat about Provider Enrollment Revalidation

Aug 27, 10:00 AM – 11:00 AM EDT

A POE A/B MAC Collaborative Event: MSP Employer Based Plans

Aug 27, 10:30 AM – 12:00 PM EDT

Website Navigation for Part A Providers

Aug 27, 11:00 AM – 12:30 PM EDT
 
 
 
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Local Coverage Determination and Article revisions August - September 2019

Posted Aug 23, 2019


MLN Connects® for Thursday, August 22, 2019

Posted Aug 22, 2019


Ambulance Fee Schedule and Medicare Transports Booklet

Posted Aug 21, 2019


CMS to Begin Using MFA Process for Online Provider Enrollment System Applications

Posted Aug 21, 2019


MLN Connects® for Thursday, August 15, 2019

Posted Aug 15, 2019

Go to All Production Alerts

Hospice NOE RTPs for ZIP Codes


Date Reported

7/12/19

Status

Closed

Provider Type(s) Impacted

Hospice

Date Resolved

8/19/19

Reason Code(s)

32114

Claim Coding Impact

Hospice Notice of Elections (NOEs) Returned to Provider (RTP)

Description of Issue

NOEs submitted beginning 7/1/2019 are being RTP for the provider ZIP Code. The reason code the NOEs are receiving is 32114. It has been determined the issue is in the FISS and only impacting EMC submitted transactions.

National Government Services Action

After additional research, the problem was identified and NGS is working with FISS to ensure the Internal Facility Zip Code Switch is not set to validate the Facility Zip Code field for TOBs 8XA, 8XD and 8XE.

Provider Action

NGS offers this workaround, for the time being. Providers can add the FAC ZIP to the claim in FISS using DDE.

8/19/2019: Providers may now submit their RTPd claims.

Proposed Resolution/Fix

Fix installed 8/19/2019.

Provider Enrollment Alert ‒ Issues resulting from recent Provider Enrollment, Chain and Ownership System (PECOS) release.



Date Reported

6/30/19

Status

Closed

Provider Type(s) Impacted

All Provider Types

Date Resolved

7/19/19

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

On 6/30/2019, PECOS Release 7.37 was implemented. This release was prescheduled and designed to bring efficiencies to Medicare Administrative Contractors (MACs) and providers who use PECOS. While many aspects of the release were successful, a small component associated to changes made to existing and new group reassignments, was found to be problematic post-implementation. As a result, data flows from PECOS to the Multi-Carrier System (MCS) for these changes have been delayed for all MACs to proactively correct the identified issue.

CMS has assembled a team with accountability for resolving this issue. The team is working tirelessly to resolve the issue by July 16, 2019.

Potential Questions and Answers that you may have:

Q: Can I continue to submit enrollment applications?

A: Yes, please continue to submit applications as you do today. Internet-based PECOS applications are the quickest method of submission and processing, although you may submit either via Internet-based PECOS web or paper applications. Application processing will continue at each of the MACs as normal. Please also continue to respond to requests for additional information.

Q: My PECOS enrollment record has been approved, but when I attempt to enroll with EDI they indicate my provider/supplier is not present in the claims system. Is additional action needed on my part?

A: No, we will update this article when a fix has been deployed and at that time you can enroll with EDI.

Q: My PECOS enrollment record has been approved but when I submit claims, they cannot be processed because the NPI/PTAN is not present in the claims system. Is additional action needed on my part?

A: No, we will update this article when a fix has been deployed and at that time you can resubmit claims for processing.

National Government Services Action

  NGS has implemented the system fix devised by CMS.

Provider Action

Providers may now resubmit impacted claims for processing.

Proposed Resolution/Fix

CMS has assembled a team with accountability for resolving this issue. The team is working tirelessly to resolve the issue by 7/16/2019.

7/22/2019: A fix was implemented on Thursday, 7/18/2019. As above, providers may now resubmit impacted clams for processing.

HCPCS Code 33249 Rejection Error RC 31160


Date Reported

3/20/19

Status

Closed

Provider Type(s) Impacted

Jurisdiction K and Jurisdiction 6 Part A Providers

Date Resolved

4/1/19

Reason Code(s)

Fiscal Intermediary Standard System (FISS) Reason Code (RC) 31160

Claim Coding Impact

Implantable Cardiac Defibrillators (ICDs), Healthcare Common Procedure Coding System (HCPCS) Code 33249

Description of Issue

CMS has identified an error for HCPCS 33249 for RC 31160. This has been referred to FISS and action is now underway.

National Government Services Action

RC 31160 was inactivated on 3/20/2019.

Provider Action

No additional provider action is necessary at this time. Please continue to check the Production Alerts section of our website and Email Updates for additional status information. 

Proposed Resolution/Fix

As above, steps have been initiated to stop these claims from rejecting.

Some Claims Submitted Electronically Between 6/14/2019 and 6/17/2019 via NGS EDI Gateway and NGSConnex Did Not Process [RESOLVED]


Date Reported

6/19/19

Status

Closed

Provider Type(s) Impacted

Jurisdiction K, Jurisdiction 6, Part A, HHH, FQHC and Part B


Date Resolved

6/20/19

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

Some claims that were submitted electronically between 5:00 p.m. ET Friday, 6/14/2019 through 5:00 p.m. ET Monday, 6/17/2019 via the NGS EDI Gateway and NGSConnex did not reach the claims systems for processing.


National Government Services Action

These claims were resubmitted 6/19/2019. As a result of the resubmission, new 277CAs were generated containing a new claim number (ICN/DCN).


Provider Action

Please do not resubmit claims sent during the affected time frame. If you receive a second 277CA for the claims submitted during the affected time frame, please disregard the original 277CA and the associated ICN/DCN. The resubmitted claims will have the original receipt date for processing.



Proposed Resolution/Fix

This issue has been resolved. All impacted claims have been successfully submitted for claims processing.


CPT Code 84153 Has Been Inappropriately Denied



Date Reported

12/31/18

Status

Closed

Provider Type(s) Impacted

All Part A and Part B Providers

Date Resolved

2/6/19

Reason Code(s)

N/A

Claim Coding Impact

CPT code 84153

Description of Issue

CPT code 84153 which is included in the biomarker testing (prior to initial biopsy) for Prostate Cancer Diagnosis LCD (L37733) has been inappropriately denied as a result of a system issue for dates of service 12/1/2018 through 12/30/2018. The issue has now been corrected.


National Government Services Action

Update 1/7/2019:A mass adjustment is planned for impacted claims but has not yet been initiated.

Update 1/9/2019: Mass adjustment for impacted claims has been delayed and is now expected to be completed in early February. Please continue to monitor this site for further details as they become available.

Update 1/22/2019: CPT 84153 continues to edit on NCD 190.31. Providers are advised to consult the NCD guidelines on this code, rather than the NGS LCD.

Update 02/01/2019: Mass adjustment on denied claims has been initiated. Please continue to monitor this site for a notice indicating completed adjustments.

Update 2/4/2019: Adjustments have been completed on impacted claims; the issue is now closed.

Update 2/5/2019: Previous notice of completed adjustments was incorrect; adjustments are now pending initiation. Please continue to monitor this site for notice of completion on the adjustment process.

Update 2/11/2019: Mass adjustment on denied claims have now been initiated. Please continue to monitor this site for a notice indicating completed adjustments.

Provider Action

No provider action is necessary at this time.

Proposed Resolution/Fix

Claims were initiated earlier than anticipated and completed on 2/6/2019.


Go to All Upcoming Education

Aug 27

10:00 AM – 11:00 AM EDT
Let’s Chat about Provider Enrollment Revalidation

Aug 27

10:30 AM – 12:00 PM EDT
A POE A/B MAC Collaborative Event: MSP Employer Based Plans

Aug 27

11:00 AM – 12:30 PM EDT
Website Navigation for Part A Providers

Aug 28

11:00 AM – 12:30 PM EDT
Adjustments Involving Medicare Secondary Payer

Aug 28

11:00 AM – 12:00 PM EDT
Provider Enrollment: Submitting Revalidations via PECOS
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