Current Processing Issues
The tables below provide an at-a-glance look at processing issues being worked currently or resolved recently.
Open Issues: Part A
| Last Updated | Issue | Resolution | Action |
|---|---|---|---|
|
7/24/2026 |
Inpatient claims billed with condition code 04 and/or 69 are being cancelled by Common Working File (CWF) Informational Unsolicited Response (IUR) adjustments. These are occurring related to changes in logic for Health Maintenance Organization (HMO) plans in CR14169. This was installed with the July 6, 2026 release. The issue has been reported to CWF. They are working on a correction to the logic. |
Providers should resubmit claims that have been incorrectly cancelled. If timely filing is a factor, please include remarks on the resubmission indicating that the claim was cancelled by CWF in error. |
Open |
Closed Issues: Part A
None at this time.
Open Issues: Part B
| Date Reported | Workload Impacted | Description/Claim Coding Impact | Proposed Resolution/Fix/Action Required | Status |
|---|---|---|---|---|
| 9/28/2026 | Part B | Incorrect denials for duplicate services when chronic care management and remote physiological monitoring services are billed on the same date of service as an E/M visit. | Incorrectly denied claims may be resubmitted or reprocessed by calling the Provider Contact Center. |
Open |
Closed Issues: Part B
| Last Updated | Issue | Resolution | Provider Action |
|---|---|---|---|
| 4/29/2026 | An issue has been identified involving claims pending in an approved to pay location for an extended period of time. This matter is being investigated as a high priority. | Our system maintainer continues to work on a full resolution; most pending claims have now been finalized. Payments have already started going out, beginning with the May 11, 2026 cycle. |
No provider action required at this time. Issue is closed |
| 2/19/2026 | We have identified claims being incorrectly rejected for invalid modifiers. | Claim logic is being reviewed for possible maintenance. | No provider action required at this time. Issue is closed |
| 2/13/2026 | We have identified claims with contractor-priced codes not pricing correctly when processing and therefore the codes are denying. | Claim logic is being reviewed for possible maintenance. | No provider action required at this time. Issue is closed |