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Provider Enrollment Revalidation Overview

Dec 6, 1:00 PM – 2:00 PM EST

Avoiding Common Claim Rejections & RTPs

Dec 9, 1:00 PM – 2:00 PM EST

Critical Access Hospital (CAH) Inpatient Billing Basics

Dec 10, 10:00 AM – 11:30 AM EST
 
 
 
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Medicare Part A facilities offer essential healthcare services to beneficiaries on an inpatient or outpatient basis.

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Go to All News Articles

January 2020 EDI Front End Quarterly Release - New and Modified Edits

Posted Dec 6, 2019


MLN Connects® for Thursday, December 5, 2019

Posted Dec 5, 2019


NGS EDI 275 Claims Attachment

Posted Dec 4, 2019


MLN Connects® Special Edition for Tuesday, December 3, 2019

Posted Dec 3, 2019


MLN Connects® for Wednesday, November 27, 2019

Posted Nov 27, 2019

Go to All Production Alerts

Part B ambulance claims submitted for emergency ambulance transport services for beneficiaries in SNFs are incorrectly denying due to an error in the Part A SNF CB edit logic. This error is impacting Part B claims for beneficiaries in covered Part A SNF stays when Part B claims are submitted for emergency ambulance transport. Impacted Part B claims included HCPCS codes: A0427, A0429 or A0433, billed with or without A0425.



Date Reported

10/22/19

Status

Open

Provider Type(s) Impacted

Ambulance providers that bill to Part B of A


Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

An error in Part A skilled nursing facility (SNF) consolidated billing (CB) edit logic is causing incorrect denials for Part B ambulance claims.

Description of Issue

Part B ambulance claims submitted for emergency ambulance transport services for beneficiaries in SNFs are incorrectly denying due to an error in the Part A SNF CB edit logic. This error is impacting Part B claims for beneficiaries in covered Part A SNF stays when Part B claims are submitted for emergency ambulance transport. Impacted Part B claims included HCPCS codes: A0427, A0429 or A0433, billed with or without A0425.

National Government Services Action

As per a CMS directive, NGS is manually bypassing the SNF CB edit for incoming Part B emergency ambulance transportation claim lines containing HCPCS code A0427, A0429, A0433, billed with or without A0425, when the beneficiary is in a SNF Part A covered stay.

Provider Action

Update 11/14/2019: Part B Providers who identify claims denied in error may request written reopening to have the claim reprocessed. Use the In Writing instructions on the Appeals page of our website to ensure your request is processed accurately. Please continue to check the Production Alerts section of our website and future Email Updates for additional status information. 

Proposed Resolution/Fix

To be announced.

NGS, along with all MACs, is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. On 10/9/19, we informed providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. CMS has now issued a corrective process for impacted Part A claims. NGS is now advising Part B providers that CMS has approved a corrective process for impacted Part B claims.


Date Reported

10/9/19

Status

Closed

Provider Type(s) Impacted

Part A claims will be resolved as stated below. NGS is now announcing a correction for Part B claims.

Date Resolved

10/22/19

Reason Code(s)

U5200

Claim Coding Impact

N/A

Description of Issue

NGS, along with all MACs, is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. On 10/9/19, we informed providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. CMS has now issued a corrective process for impacted Part A claims. NGS is now advising Part B providers that CMS has approved a corrective process for impacted Part B claims.

National Government Services Action

Update 10/14/2019: CMS has announced a resolution for impacted Part A claims, effective on 10/10/19. Part A claims previously suspended with RC U5200 will now be reprocessed by NGS.

Update 10/10/2019: NGS is now anticipating a correction for this issue. Providers are advised that impacted claims will be held and released once the correct entitlement data is available.

Provider Action

Part A providers are now advised to resubmit impacted claims rejected with reason code U5200, after verifying that the beneficiary was eligible on the date of service and the reason code was assigned incorrectly.

Update 10/18/2019: Part B providers are advised no further action is needed, we are requesting you refrain from contacting the NGS Provider Contact Center on this issue. NGS will reprocess previously denied Part B claims impacted by this issue. Reprocessing for Part B claims will be initiated by NGS on Monday, 10/21/2019.

Update 10/22/2019: Part B claim adjustments initiated.

Proposed Resolution/Fix

10/23/2019

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.

Go to All Upcoming Education

Dec 6

1:00 PM – 2:00 PM EST
Provider Enrollment Revalidation Overview

Dec 9

1:00 PM – 2:00 PM EST
Avoiding Common Claim Rejections & RTPs

Dec 10

10:00 AM – 11:30 AM EST
Critical Access Hospital (CAH) Inpatient Billing Basics

Dec 10

10:00 AM – 11:00 AM EST
Verify and Update Provider Enrollment Practice Location Addresses

Dec 10

2:00 PM – 3:00 PM EST
Submitting Revalidation via CMS-855A Paper Application
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