Claims Payment Issues Log

Here is a list of system-related claims payment and processing issues. These issues have been reported to the Centers for Medicare & Medicaid Services (CMS) and/or the Fiscal Intermediary Standard System (FISS). Please check often for updates before contacting the provider contact center. The issues are identified by stand alone articles and will be updated as needed.

Article Update Notifications

Would you like to receive a notification when one of the CPIL articles is updated? At the bottom of each article, sign up in the new Article Update Notification box, and we'll send you an email with the new article any time it changes.

Note: You can only sign up for notifications on a per-article basis; if you would like notifications for more than one, please sign up for each article individually.

Claims Payment Issues Log Articles

RESOLVED: Home Health Accountable Care Organization (ACO) Reductions Not Recouping Request for Anticipated Payment (RAP) Reimbursement with Reason Code 3719QHospice Payment Rates for Routine Home Care (RHC) on and after January 1, 2016Hospice Notice of Transfer (NOTR), Type of Bill (8XC)RESOLVED: Claims Returning for Reason Code C5467 for the Review Choice Demonstration (RCD)RESOLVED: Home Health: Reason Code 38107: Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not MatchRESOLVED: Home Health: Reason Code U5391, Fields on the Requests for Anticipated Payments (RAPs) and Final Claim Information Do Not MatchRESOLVED: Home Health Reason Code C727E - Home Health PDGM Claims are Suspending Incorrectly with Reason Code C727ERESOLVED: Home Health Reason Code 37253 - Claims Returned to Provider (RTP) Due to OASIS Assessment Not FoundHospice Claims Editing for Reason Code U5181RESOLVED: Home Health: Penalty for Requests for Anticipated Payments (RAPs) Received More Than Five Days EarlyRESOLVED: No Payment Amount on Low Utilization Payment Adjustment (LUPA) Claims with Late Requests for Anticipated Payment (RAP) PenaltiesHospice Period Dates Not Calculating Correctly on the Common Working File (CWF)Recoding of Health Insurance Prospective Payment System (HIPPS) Codes from Late to Earlier Periods on Home Health Claims When There Is Separation Between the Periods of Less than 60 DaysRESOLVED: Home Health HIPPS Recoding Error Affecting Claims that Span January 1, 2020Home Health: Penalties for Late Requests for Anticipated Payments (RAPs) Not Being Deducted from Final ReimbursementHome Health: Medicare System Not Recoding the Health Insurance Prospective Payment System (HIPPS) Code on Some ClaimsHome Health Reason Codes U524P/U524Q - Some Home Health Final Claims are Cycling in the System for the Timing of the Period/EpisodeHome Health: Payment on Claims When the Requests for Anticipated Payment (RAP) Were Submitted More than 30 Days LateRESOLVED: Hospice Reason Code U5106: Notices of Elections (NOEs) Posting Elections to the Common Working File, But Returning to ProviderRESOLVED: Home Health Reason Code W7216 - Requests for Anticipated Payments (RAPs) Returned to Provider (RTP) Incorrectly for an Invalid Line Item DateRESOLVED: Home Health: 2020 Requests for Anticipated Payments (RAPs) UnderpayingRESOLVED: Home Health: Claims Spanning 2020-2021 Not Applying Correct 2021 Payment RateRESOLVED: Home Health: Low Comorbidity Adjustment for Claims with COVID-19 Diagnosis Code U07.1Sequestration Reduction Applied Incorrectly on April 2021 Dates of ServiceHome Health: Reason Code 37363 Editing on Low Utilization Payment Adjustment (LUPA) ClaimsHome Health: Reason Code 37257, Missing or Invalid Federal Information Processing Standards (FIPS) County CodeRESOLVED: Home Health: 2021 Payment Adjustment for the Home Health Value Based Purchasing (HHVBP) ModelRESOLVED: Home Health: PCR Duplicate Request Rejections