Method II CAH Claims Incorrectly Denying With Practitioner Reassignment on PECOS
Method II CAHs in Jurisdiction 6 and Jurisdiction K
Description of Issue
CAH claims are receiving reason code 31006 or 31007 in error when the reassigned physician’s NPI is accurately reported in PECOS.
National Government Services Action
NGS will suspend claims to S/LOC SMP900 until FISS is updated to correct this issue. Update 8/13/2025: Claims will be released the night of 8/13/2025.
Provider Action
Ensure all eligible health care providers that reassigned their benefits to a Method II CAH are accurately reported in PECOS under the CAH’s Part A enrollment.
- The individual provider must submit CMS-855I application to add the reassignment to the CAH enrollment using the Part A Medicare identification number (PTAN).
- A CAH can add reassignments through the PECOS Part A CAH enrollment if the individual provider has an active enrollment in PECOS for the same state.
Proposed Resolution/Fix
FISS and CMS are working on a fix to correct the inappropriate editing. NGS will mass adjust claims impacted once the issue is resolved.
Update 8/13/2025: FISS and CMS instructed NGS to inactivate reason code 31006 and 31007. Claims denied for these reason codes will be adjusted on 9/2/2025.