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Let’s Chat about Provider Enrollment Revalidation

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Fundamentals of Medicare - Part One

Oct 22, 11:00 AM – 1:00 PM EDT

Provider Enrollment: Submitting Revalidations via PECOS

Oct 24, 1:30 PM – 2:30 PM EDT
 
 
 
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Go to All Production Alerts

NGS, along with all MACs, is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. NGS is informing providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. This is causing claims to incorrectly deny based on invalid beneficiary entitlement.


Date Reported

10/9/19

Status

Open

Provider Type(s) Impacted

Part A claims will be resolved as stated below. NGS is awaiting CMS instructions for Part B claim corrections.

Date Resolved

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 and NGS is awaiting further instructions 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 correctly.

Part B providers are advised to await additional instructions. Please continue to monitor this site for updated information.

Proposed Resolution/Fix

10/10/2019

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.

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.


Go to All Upcoming Education

Oct 22

9:00 AM – 10:00 AM EDT
Let’s Chat about Provider Enrollment Revalidation

Oct 22

11:00 AM – 1:00 PM EDT
Fundamentals of Medicare - Part One

Oct 24

1:30 PM – 2:30 PM EDT
Provider Enrollment: Submitting Revalidations via PECOS

Oct 29

11:00 AM – 12:00 PM EDT
Let’s Chat about Medicare Secondary Payer Part A

Oct 29

1:00 PM – 3:00 PM EDT
Fundamentals of Medicare - Part Two
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