Method II critical access hospitals: Reprocessing certain claims with reassigned billing rights
Method II CAHs bill for facility and professional outpatient services only when physicians or practitioners reassign their billing rights to the CAH. CAHs must submit the reassignment application through PECOS or the paper form CMS-855I.
Certain CAH claims were incorrectly returned with Fiscal Intermediary Shared System (FISS) reason codes 31006 and 31007 indicating that providers don’t have a reassignment on file in PECOS. To address this issue, MACs stopped returning these claims with dates of service in 2025 and 2026. They will reprocess claims that incorrectly returned since January 1, 2026. Payments should be issued in approximately two weeks. CAHs do not need to take any action.
You can get claims status information in SPOT and through FISS Direct Data Entry. If you identify any discrepancies, contact your MAC.
Physicians and practitioners: Make sure you accurately reassign benefits to CAHs; see the Information for CAHs booklet for more information.
Change Request (CR) 13900, titled "Editing for Duplicate Processing for Practitioner Professional Services and CAH Professional Services", was introduced to ensure that reassignment information for physicians was on file in PECOS when method II CAH claims for professional services were submitted.
Provider actions
Make sure you are accurately reassigning benefits to the CAH under the CAH's NPI.
Reassignment applications: Providers must ensure that all eligible health care professionals who reassigned their benefits to a CAH are correctly reported in PECOS. This includes submitting the necessary enrollment application (using PECOS or the paper form CMS-855I) to record the health care professional's reassignment under the CAH’s Part A enrollment.
To add the reassignment to the CAH’s enrollment record, submit the application using the Part A Medicare identification number of the CAH hospital (not the clinic’s enrollment). This identification number is the NPI and CCN (6-digit CMS Certification Number) of the CAH’s enrollment record.
Submission deadlines: CAHs are encouraged to submit these applications promptly so that First Coast can process them before the reason codes are reactivated in the future. This will help avoid unnecessary claim RTPs when the edits are re-enabled.
Educational resources: CMS and the A/B MACs (A) will continue to provide educational resources to guide providers through the process of reassignment reporting.
Next steps and claims adjustments
Claims adjustment: For claims with dates of service on or after July 1, 2025, where professional service revenue codes 096X, 097X, or 098X were denied with reason codes 31006 or 31007, First Coast has taken appropriate steps to reprocess these claims on March 30, 2026.
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