FISS HOLDS and PROBLEMS  
Last revision: 08/13/2008  
  FISS Holds and Problems  
Issue/Date Identified Claims Held/Problem Reported Estimated Correction Date
8/11/2008 It appears that when the new MPFS rates were loaded for Louisiana, some of the lab codes did not have the rate applied.  The claims with lab only charges suspended and we corrected the HCPCS file and processed the claims correctly.  Rates did not post on claims billed with lab and other charges, these claims processed incorrectly.  We will be adjusting these claims along with the adjustments being done for the MPFS claims that paid with incorrect percentage.  Will be completed by 9/30/2008
7/23/2008 CMS has instructed us to hold all ambulance claims, until further notice.  Claims were released once files were loaded into production. 8/7/2008
7/1/2008 CMS has instructed us to hold claims paid under the MPFS for 10 days, until further notice. Claims will be cycled through SMHOKX locations each day and claims that are 10 days old will be released from the edit WW100.  If the claim has CC 15 before release, it may take an extra day. All held claims were released for processing. Dur to the volumne held, the claims were release on two separate days.  First batch was release 7/28/2008 and the remaining were released 7/29/2008. 7/29/2008
6/26/2008 Claims are still looping with V8015.  A fix was installed recently but some claims are still looping.  Currently under research. Unknown
6/26/2008 There is a problem viewing claims in TB9997.  Only a few claims will appear.  This affects providers and internally.  Our Data Center has dealt with issue before and expects it to be resolved soon.  There is no estimate on time but we hope to have it resolved today. 6/26/2006
6/23/2008 Due to problems at the Enterprise Data Center (EDC), EMC claims that were submitted on 6/18/08 before 5:00 pm show a receipt date of 6/19/08.  Unfortunately, the EDC failed to run the backdating process for the 6/18 submission.   N/A
6/18/2008 There was a problem with the financial cycle on 6/17/2008.  The problem has been reported.  We hope to have problem corrected soon.  The financial region will be down until the payment cycle runs.  No Remits will be posted until the completion of the cycle.  We hope to have cycle run and remits posted by noon 6/18/2008.  6/18/2008
6/5/2008 Contractual Adjustment amount appears under different adjustment reason and group code as of the 6/4/08 Remittance Advice.  This affects inpatient claims.  The cause is identified and a fix in place.  Installation of the fix is unknown.  This does not affect the payments, only improper code assignments. 7/7/2008
6/5/2008 Problem reported related to rates disappearing from claims filed DDE.  Cause has been identified and a fix is in place.  Providers need to assure they press the enter key after their charges have been keyed.  This should cause the rate(s) to be retained.  The provider may then scroll forward using the PF8 key.  This workaround only pertains to providers manually keying claims via DDE.  The workaround for this problem is not longer needed, the correction was approved and installed earlier than expected. 6/23/2008
6/3/2008 19201 is RTP'ing back to provider due to the changes stating UPIN number is no longer required.  Providers should access their claims, page over PAST page 3 and THEN PF9 the claim.  At that point the system will allow the claim to store and remove the UPIN automatically.  A system change to correct this problem should be installed 6/8/2008, in the meantime, this is a workaround for the providers. 6/9/2008
5/28/2008 Claims are suspending from CWF with reason code E9352.  This is a CWF system problem and should be resolved by 6/2/2008.  Once resolved, all claims can be PF9'd to recycle back through CWF.  6/2/2008
5/23/2008 Providers are not able to use their NPI to correct or view claims in DDE.  This appears to apply only to those that were setup prior to 5/19/08 when the system change took place.  This has been reported to FISS.  There is no ETA at this time. 5/27/2008
5/6/2008 Per CMS instructions, we are holding Pap Smear claims containing code Q0091 until FISS has loaded changes to insure coinsurance is calculated correctly.  Claims are being held in SM8294 and will be released when fix is installed.  We have recently been informed by CMS to continue to hold these claims until 9/2/2008. 9/2/2008
4/30/2008 We have several claims pended for reason code 39910 in error.  The  Grouper is returning an incorrect DRG (999) and creating a negative payment.  This problem has been reported and a fix in in process (R20845R1).  Once PAR is installed the claims will need to be sent back thru FISS from the starting driver to allow payment recalculation.  Claims are being held in status location SMHDRG.  25 pended claims were released 5/13/2008. 5/12/2008
4/29/2008 CAH claims are incorrecty assigning E61#8, when the claims contain valid blood codes.  The fix for this problem is currently being worked on and is expected to be installed in October 10/1/2008
4/17/2008 DSMT is editing incorrectly due to incorrect information written into CR5433.  CMS will be issuing a new CR. 10/1/2008
4/4/2008 There is a hold for OPPS claims due to PRICER being installed late. WW106 is current edit which is holding the claims. 4/10/2008
4/4/2008 CMS advised all FI's to hold all claims until 4/8/2008 in the event to prevent thousands of claims possibly paying incorrectly if there were NPI problems resulting from installing the April release.  CMS advised Tuesday that claims could be released.  5892 claims were released. 4/8/2008
3/10/2008 Western MO carrier code 00740 was changed to the new J5 MAC carrier ID 05032 effective 3/1/08.  The locality code 02 was added to the provider files instead of 99.  This is causing the reimbursement to be higher (as 02 has an avg higher reimbursement rate).  Some files were changed back to 00740 due to mis-interpretation of the change, which made have caused some claims to RTP. As of 3/18/2008, carrier code issue is resolved. The locality codes will be restored internally and once complete, claims will be adjusted.  The amount of time to complete is not known.  Time did not allow for adjustments to be identified and adjusted prior to WPS conversion.  WPS will handle adjustments. 4/30/2008
3/7/2008 Providers on DDE are receiving the following error when correcting some RTP'd claims "ERROR HAS OCCURRED IN : FSSO245F AT : 32438  STATUS IS : ABEND" .  FISS is currently working on a fix for this issue.  Problem corrected 3/17/2008. 3/17/2008
1/11/2008 Claims are being RTP'd in error for 34929.  FISS is working on a fix and hope to have it installed by end of the week or early next week. Fix is set to go on 1/20/2008 and claims will no longer suspend incorrectly beginning 1/21/2008.  Problem was corrected 1/20/2008.  Providers have contacted us stating they are still having the issue with 34929.  CMS has been contacted and they are working on getting instructions out to the FI's on how to proceed.  Once CMS advises how to handle, this site will be updated.  Problem corrected 3/5/2008. 3/5/2008
1/8/2008 The claims audit trail is not tracking the activity for the claim.  We have many examples indicating claims have been in house for several weeks yet it shows only the date the claim was processed on the audit trail.  Providers have claims they corrected that were in an RTP status yet on the audit trail they never show being in an RTP location.  This appears to only be a CDS problem.  Issued resolved 1/28/2008. 1/28/2008
1/8/2008 It has been reported that some claims have posted to the remittance advice AND posted to CWF but are showing in an RTP status on our online system.  If providers try to correct the claims, the system acts strange and sometimes will clear off the screen and they will have to start over.  Also, IF they do work the claim and it is already posted to CWF and the remit, it will come back from CWF as a U5600 duplicate.  This also appears to only be a CDS problem.  This issue should have been corrected along with the history restore on 1/16/2008.  If providers are still having this issue, please send that information as soon as possible so we can begin researching.  We have received notification that this is still occurring. CDS is researching.  FISS has created a correction to this issue and are currently testing before releasing.  No estimated date had been giving for the release. Unknown
1/8/2008 The following HCPCS codes are being held on claims with service dates beginning 1/1/2008 until a new IOCE and Pricer are received:  A9517,A9530,A9543,A9545,A9563,A9564,A9600, A9605,A9527,C1716,C1717,C1719,C2616,C2634, C2635,C2636,C2638,C2639,C2640,C2641,C2642, C2643,C2698,C2699.  These claims will be held under status location SMOPHO with reason code 74082. 1/28/2008
1/7/2008 When attempting to correct claims, some claims are not allowing a correction to be stored and are posting a V in the next to last position of the DCN.  This also appears to only be a CDS problem.  This also has been reported to the Data Center and they are researching to create a resolution.  FS4937R1 has been scheduled for installation 1/20/2008.  Problem was corrected 1/20/2008.  We have just realized the problem also existed in EDS.  The fix that was installed has prevented this from happening did not give consideration to the claims that were stored with a 'V' in the DCN and RTPD'd to the providers.  After fix was installed, providers are attempting to correct their claims and the 'V' is remaining in the DCN.  This issue and request for assitance in clearing up the problem has been submitted to the Data Center.   3/8/2008
1/7/2008 There are hundreds of claims missing from FISS online history.  This seems to only be a CDS problem.  We have reported the issue and are working with the Data Center towards a resolution.  This is also causing other claims to receive erroneous edits and could potentially create a duplicate payment issue.  If the provider files a duplicate claim and the original claim is missing from history, the duplicate claim could potentially pay, then when the originals are posted back to history, it would create duplicate payments.  The missing claims were posted back to the online history last night.  There was a total of 81,403 claims re-posted.  If you still have claims that you feel should be on history and they are still not posted, please send that information to us as soon as possible so we can research begin researching.   1/16/2008
1/7/2008 MAP1755 on the Beneficiary Inquiry screen in DDE is displaying the LST BILL DT for both current and prior data as 071800 for all inquiries.  Problem has been identified as a layout issue, not a system problem, estimation of fix is unknown and providers will need to use other means of getting information in the meantime. Unknown
11/1/2007 Claim are continuing to cable with reason code V8015 indicating an incorrect deductible.  This is an FISS problem that is on schedule to be corrected with the April 08 release.  PAR FS4877 contains the FISS corrections.   6/2/2008
10/1/2007 Claims with Reason Code 31999:  Claims that receive 31999 will be held in SMHZIP.  Inpatient claims will be bypassed by SuperOp.  There is an issue with this code that is currently being researched by CMS and FISS, in connection with it suspending for providers who should be exempt.  (The hold on outpatient claims is not mandatory, but due to the high volume of claims, it was decided to hold instead of RTPing them.) CMS has approved the deactivation of 31999.   2881 claims have been released. 11/30/2007
8/31/2007 Based on a CMS JSM, we are suspending 85X claims with revenue codes 96X, 97X, 98X  with 74002 in SMHHOL.  These claims will be reviewed and if W7013 error is received, the edit will be bypassed and claim will process.  A fix for this is due in the October 07 release. 1/1/2008
12/1/2007 We are unable to successfully retrieve claim histories.  This problem is causing a lot of adjustments to not be preformed in a timely manner.  FISS has been working toward a solution and has tried several fixes which have not worked.  The most current fix is scheduled to be released in July 2008. 9/4/2008
  Based on CR5432, we are holding Intracranial PTA claims in SMHPTA with reason code 72004.  The change to allow these codes should be included in the October 07 release. 10/1/2007
Jan-07 CWF  adjustments are suspended for 30916 and when releasing claims, 30954 is received.  The claims are using the wrong uniform bill code carried over from the original claims.  CMS is in the process of issuing a JSM to allow 30954 to be bypassed. (JSM directed 30954 to be deactivated and 650 claims were released).  8/24/2007
5/9/2007 Claims appear to be receiving E46#R for all 038x rev codes, and not just the ones listed.  FISS and CMS are aware of the problem.  No fix has been scheduled at this time.  CMS gave clarification on this and doesnt appear to be a system problem but a matter of processing requirements. As of review on 4/30/08, there appears to be no claims suspended.  This issue is considered resolved. 4/30/2008
4/24/2007 Reason code 74075 was created to RTP all claims billed with HCPCS code J7187.  The external narrative advises provider how to handle claims. 10/1/2007
4/18/2007 CMS issued JSM07328 indicating we should hold all adjusted claims billed with HCPCS code J7187 with discharges between 1/1/2007 thru 9/30/2007.  A release should be out in October 2007 to correct the coding for the 'J' code.  Reason Code 74077 was created to catch the claims. 10/1/2007
4/11/2007 CMS issued JSM07344 advising FI's that adjustments will need to be performed on 12X mammography claims on dates of service on or after 4/1/2007 billed with HCPCS codes 77055, 77056, G0204 or G0206.  CAH providers XX1200 - XX1399 are exempt from these adjustments. FISS changes have been installed.  Coding for adjustments has begun. Research indicated no claims were needed for adjustment - 9/10/2007.
4/11/2007 CMS has advised that once a FISS release is installed to handle unsolicited responses, Inpatient IRF providers will begin to notice their claims being canceled and reprocessed with correct patient status code to ensure claims  payments are calculated correctly.  New edit, C729H,  was created to capture these claims. 5/6/2007
2/26/2007 ESRD Claims are paying without the ESRD Reduction.  Problem has been identified and is in the process of being fixed.  The correction has been made and fix installed on 4/2/07. 4/2/2007
1/17/2007 Claims were erroneously cancelled as HMO recoupments and the beneficiaries did not have HMOs during the date of service.  CMS, CWF, and the contractors are coordinating efforts to ID the claims and have them reprocessed. All affected claims has been adjusted. 4/1/2007
1/17/2007 Claims for Rehab providers with 'T' in the third position of the provider number are paying using the incorrect wage index.  Once correction is installed a query will be performed to determine the action to take in adjusting claims.    7/2/2007
12/28/2006 CMS advised we are to hold type of bills 71X claims billing revenue code 90X until FISS change is installed to correct problem.  Claims are held under SMPSHO with reason code 74078.  PAR MO0144 in the C2007300 release is to fix problem and should be installed 7/2/2007.  FISS has installed the correction and 3916 pended claims were released 7/5/2007.   7/2/2007
12/5/2006 CMS advised we are to hold IPF claims with return code until the April 2007 IPF Pricer is installed.  These claims are held under SMHOKM with reason code 37303.  Pricer was installed and held claims released. 4/2/2007.
11/15/2006 CMS advised we are to hold type of bills 14X claims billing mammography for dates of service 10/1/2004 - 12/31/2005.  Claims are held under SM7067 with reason code 74076. 6/4/2007
11/2/2006 IRF claims dating back to CY 2002/2003 are suspending for 39910 because reimbursement has not been calculated.  Cause has been identified as the IRF pricer not available for those years.  These claims are payable as part of an OIG project related to a status code correction. FS4897 was created and assigned to release C2007300 which should be installed 7/2/2007. FISS has installed the correction and 16 pended claims were released 7/5/2007.   7/2/2007
9/29/2006 CMS advised we are to hold claims billing Pancreas Transplant Alone (PTA) with a discharge 4/26/2006 - 9/30/2006 until a system correction is released.  Claims are held under SM6704 with reason code 72004. 10/4/2007
7/20/2006 Claims with EPO units that exceed the limits are rolling all units to one line and suspending with reason code 36330 line level and 31953/31960 claim level.  Cause has not been identified and no resolution is yet available.  Claims are being held in SM3633.  Claims have been able to process randomly due to manual intervention by the claims area.  But claims are still bound to roll the units and some claims may not be able to process.  A fix is currently scheduled to be installed in early September. 9/8/2008
6/10/2006 Claims for LTCH providers are incorrectly receiving 37077 edit.  The internal provider file has an error that is preventing claims with dates of service prior to 7/1/2006 from processing.  Problem should be corrected 7/17/2006 and claims will be released 7/18/2006.  Problem was corrected and claims have been released.   7/17/2006
6/7/2006 Claims were being held with reason code HCP06 to validate pricers.  Claims are being released 7/14/2006.  Claims have been released. 7/14/2006
6/7/2006 Claims incorrectly suspended and RTP'd with reason code 36356 due to a system problem with an internal ESRD file.  Problem was identified and corrected 7/13/2006 and claims will be released 7/14/2006.  Claims have been released. 7/14/2006
5/4/2006 CMS issued Katrina related instructions regarding Louisiana providers that should not be submitting claims at this time.  These provider have had holds placed against them to catch any claims that may be filed.  SMHKAT is the holding location for any claims that may be filed. N/A
5/2/2006 CMS has instructed FI's to hold ESRD claims billing EPO due to an incorrect load of a file within FISS.  The claims are being held in SMHEPO. Correction should occur with the installation of the June FISS release.   Claims were released June 8, 2006. 6/5/2006
5/2/2006 Reason code 74064 was created to hold claims relate to JSM 06410 which states we are to hold claims for CAH billing revenue code 0964.  These claims are being held in status location SMHCAH.  Claims were released June 7, 2006. The system changes did not correct the problem with incorrect payments, therefore, edit 74064 was re-created to hold claims until further notice.  These claims are currently being processed by removing the HCPCS code billed with 0964 and changing rev code 0964 to 0379. 7/6/2006