Published on October 24, 2012
Update: CMS has implemented a resolution to these issues. If you received the edits below and have not already entered those claims into the Direct Data Entry (DDE) system, you may now resubmit your affected claims. If you have entered the affected claims into the DDE system, no further action is necessary.
Update Sent 10/10/2012: The incorrect claim rejections for Issue #2 below will contain the following error messages:
Reject Code: A7:732:DN Message: ACK,REJCTD FOR INVAL INFO-CLAIM,ENCNTR HAS INVAL INFO AS SPCFIED IN STATUS DTAILS AND BEEN REJCTD.:REFERRING PROVIDER
Reject Code: A7:560:DN Message: ACK,REJCTD FOR INVAL INFO-CLAIM,ENCNTR HAS INVAL INFO AS SPCFIED IN STATUS DTAILS AND BEEN REJCTD.:ENTITY'S ADDITIONAL, SECONDARY IDENTIFIER:REFERRING PROVIDER
Original Notice Sent October 5, 2012:
The Centers for Medicare & Medicaid Services (CMS) has reported the following two issues impacting all Medicare contractors:
Issue #1: Occurrence code 55, which was implemented with Change Request 7792, is required to be reported when the discharge status code reported on the claim is:
40 (expired at home)
41 (expired in a medical facility)
42 (expired - place unknown)
However, 5010 claims submitted with the occurrence code 55 are being rejected before entering the Fiscal Intermediary Standard System (FISS). This problem affects all provider types.
Issue #2: Change Request 7755 requires hospice providers to report the certifying physician information (when different than the attending physician) in the referring physician 2310F loop on 5010 claims. However, these claims are being rejected before entering FISS. This problem is currently only affecting hospice providers.
CMS is working to resolve these issues as quickly as possible. Please be aware of these CMS processing issues.
If you have any questions, please contact Client Services at 1-888-348-8457, option 2.