The Part B Claims Issues Log below includes the current status of claim processing issues that have been identified. We are actively working with the necessary areas/entities to resolve these issues.
If your claim issue is not identified below, please visit our Frequently Asked Questions page, available on the left navigation pane, to view top inquiries on claim status, claim denials, and other topics.
Please review this information before calling our Provider Contact Center:
Providers / Impacted
Description/Claim Coding Impact
Proposed Resolution/Fix/Action Required
Not Otherwise Classified (NOC)/Unlisted Drugs
Effective October 1, 2018, CMS established ASP fees for two NOC drugs, Fasenra (Benralizumab) and Cinvanti (Aprepitant). It has been discovered that some of the claims submitted for these two drugs that processed between 10/1/2018 – 12/31/2018 were not processed using the newly established fee.
Adjustments to the impacted claims will be performed.
No provider action will be necessary.
Claim rejections associated with reference lab and anti-markup payment limitations
Certain laboratory service claims associated with reference lab and anti-markup payment limitation services were rejected due to invalid system editing.
As a result of this issue, the edits have been disabled. Providers and suppliers who have claims that rejected in error for this editing may resubmit their previously returned claims. MACs shall also adjust claims when brought to their attention.
On January 1, 2019, Local Coverage Determination (LCD) L35101 (Psychiatric Codes) implemented the new CPT codes, 96138 and 96139, and 96146 as non-covered.
The LCD was revised and published on February 28, 2019. The revisions are effective for dates of service on and after January 1, 2019, and removes CPT Codes 96138, 96139 and 96146 from non-covered and adds them to CPT Code Group 1 and ICD-10 Group 1 Paragraph as covered.
Procedure codes 96138, 96139 and 96146 were denied based on the non-covered policy decision. Since the policy has been updated, these claims will be automatically reprocessed. No provider action is needed.
Inappropriate Denials for Some Pathology Services
Due to a system edit, some claims for pathology services (CPT Codes 88300, 88302, 88304, 88305, 88307, 88309, 88331, 88332, 88341, 88342, or 88344) have been denied in error.
Adjustment to impacted claims will be performed.
Medicare Diabetes Prevention Program (MDPP)
It has been discovered that suppliers who are enrolled with Medicare as a participant in the Medicare Diabetes Prevention Program and also have other Provider Identification Numbers (PIN) tied to the same National Provider Identifier (NPI) number are receiving incorrect claim denials or rejections. The Multi-Carrier System (MCS) used to process Part B Medicare claims is not always selecting the most appropriate PIN for the services submitted.
Impacted edits have been set to suspend claims for manual review until a solution can be installed.
Impacted claims that received the incorrect denials/rejections will be adjusted.
MIPS: Error in 2019 Payment Adjustment
Recently, CMS discovered an error in the implementation of the 2019 Merit-based Incentive Payment System (MIPS) payment adjustment; it incorrectly applies payments for Medicare Part B drugs and other non-physician services billed by physicians.
Adjustment to impacted claims will occur in the near future:
Inappropriate Denials for Extracranial Doppler Imaging
Due to a system edit, some claims for Extracranial Doppler Imaging (CPT Codes 93880 and 93882) have been denied in error.
Physician Anesthesia Claims for SNF Patients
Some anesthesia claims for 2018 dates of service were incorrectly denied for Part B skilled nursing facility consolidated billing:
HCPCS codes 00731, 00732, 00811, 00812, and 00813
Claims for these services will automatically be reprocessed by the Medicare Administrative Contractors beginning January 28.
Claims submitted with some beneficiary Medicare numbers.
Novitas has escalated two problems involving the processing of claims with certain beneficiary Medicare numbers:
Scenario 1 - Claims have suspended and are unable to be released at this time.
Scenario 2 - Claims are incorrectly rejected as a mismatch between the beneficiary name and Medicare number reported on the claim.
Scenario 1 - We continue to work with the appropriate contractor to identify a fix that will allow claims to continue processing. Novitas appreciates your patience and understanding while the maintainer researches this problem. To avoid duplicate denials, please do not resubmit impacted claims that have not yet finalized.
Scenario 2 - If you received this rejection and have confirmed the beneficiary name and Medicare number reported is correct, please do not resubmit the claim(s) at this time. Once the system maintainer has resolved the problem, we will update this issue to notify impacted providers that they can resume normal claim submission for these beneficiaries.
Please note that this problem does not impact all beneficiaries. We do not recommend holding all Medicare claims.
Claims for beneficiaries eligible as a Qualified Medicare Beneficiary (QMB) (CR9911)
On October 2, 2017 Change Request 9911 modified the Medicare Remittance Advice (RA) for Qualified Medicare Beneficiary (QMB) claims to identify QMB patients and reflect zero cost-sharing liability. This change resulted in unanticipated issues for providers, states, and other secondary payers who are used to seeing Medicare deductible and coinsurance amounts in specific fields on the RA.
Complete information about the Qualified Medicare Beneficiary (QMB) Program is available on the CMS website.
Beginning December 8, 2017, CMS systems will revert back to the previous display of patient responsibility for QMBs on RAs. Providers may want to hold QMB claims and submit them after December 8.
In the interim for Medicare claims received between October 2 and December 7, 2017, please visit the CMS website for the Qualified Medicare Beneficiary (QMB) Program for the recommendation on handling these remittances.
Update 3/26/18: For claims processed on or after July 2, 2018, CMS will reintroduce QMB information on the Medicare remittance with revised coding from what was implemented with CR9911. Refer to MM10433 for more information.
Claims that processed with the QMB information prior to December 8, 2017, will be identified and automatically reprocessed. No provider action will be necessary. Refer to MM10494 issued by CMS for additional details.