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Some Claims Suspensions Are OK, MAC Says
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Don’t get worried if you see a suspended claim in FISS, HHH Medicare Administrative Contractor CGS tells providers on its website.
“CGS continues to receive a high volume of calls from home health and hospice providers regarding claims that are in a suspended S/LOC. These claims can be identified in the Fiscal Intermediary Standard System (FISS) by a status code beginning with an ‘S’ (example: S B0100),” the MAC says.
“All Medicare billing transactions will temporarily suspend in different S/LOCs as they process through FISS.”
Generally, CGS advises, providers only need to take action when they have claims in S B6001 (indicating CGS has requested an additional development request to assist with adjudicating a Medicare claim) or T B9997 (indicating the claim is suspended in the Return to Provider file due to missing or incorrect information. Providers need to access the RTP file to correct the claim.).
Exception: “Claims may suspend due to system issues that prevent Medicare billing transactions from processing appropriately,” CGS adds.
“Billing transactions impacted by these issues may be suspended for more than 30 days.” You can keep tabs on system issues at www.cgsmedicare.com/hhh/claims/fiss_claims_processing_issues.html.
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