RESOLVED: Information-Only HMO Claims Rejecting in Error

Published 09/29/2026

Table 1.
RESOLVED: Information-Only HMO Claims Rejecting in Error
Current Status Date  
Resolved  September 29, 2026  Status: The CWF Maintainer implemented corrections to the system logic on August 17, 2026. 
Provider Action: Any XXG claims recouped in error with a receipt date on or after July 6, 2026, may be resubmitted as an original claim (not as an adjustment).
Update August 11, 2026 Status: This issue extends to any Health Maintenance Organization (HMO) related claim with various reason codes, including U5233. Affected claims may be identified by an XXG cancellation type of bill (TOB) generated by Common Working File (CWF) in error.
Provider Action: Any claims recouped in error with an XXG TOB and receipt date on or after July 6, 2026, must be resubmitted as an original claim (not as an adjustment).

Update

August 5, 2026 Status: Inpatient claims billed with condition code 04 and/or 69 are being cancelled by CWF Informational Unsolicited Response (IUR) adjustments with reason code U5233.
Provider Action: Providers may resubmit claims that have been incorrectly cancelled by CWF in error. If timeliness is an issue, please add remarks on claim, "Previous claim cancelled in error due to HMO issue. CWF was updated 07/06/26."
Open July 30, 2026 Status: Inpatient claims billed with condition code 04 and/or 69 are being cancelled by CWF Informational Unsolicited Response (IUR) adjustments with reason code U5233. The issue was reported to CWF Maintainer. CWF will implement a correction to the logic on August 17, 2026.
Provider Action: Providers may resubmit claims that have been incorrectly cancelled by CWF in error.
Issue Description
Inpatient claims billed with condition code 04 and/or 69 are being cancelled by CWF IUR adjustments. These are occurring related to changes in logic for HMO plans in Change Request 14169. This was installed on July 6, 2026.

 


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