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[Update 4] Beneficiary Entitlement Date Errors Causing Incorrect Part A and Part B Claim Denials - R

Thursday, October 24, 2019   (0 Comments)
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[Update 4] Beneficiary Entitlement Date Errors Causing Incorrect Part A and Part B Claim Denials - Revised

Date Reported: 10/9/2019
Status: Open
Provider Type(s) Impacted: Part A claims will be resolved as stated below. NGS is now announcing a correction for Part B claims.

Reason Code(s): U5200
Claim Coding Impact: N/A

Description of Issue

National Government Services (NGS), along with all Medicare Administrative Contractors (MACs), is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. On 10/9/2019, we informed providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. CMS has now issued a corrective process for impacted Part A claims. NGS is now advising Part B providers that CMS has approved a corrective process for impacted Part B claims.

National Government Services Action

Update 10/14/2019: CMS has announced a resolution for impacted Part A claims, effective on 10/10/19. Part A claims previously suspended with RC U5200 will now be reprocessed by NGS.

Update 10/10/2019: NGS is now anticipating a correction for this issue. Providers are advised that impacted claims will be held and released once the correct entitlement data is available.

Provider Action

Part A providers are now advised to resubmit impacted claims rejected with reason code U5200, after verifying that the beneficiary was eligible on the date of service and the reason code was assigned incorrectly.

Update 10/18/2019: Part B providers are advised no further action is needed, we are requesting you refrain from contacting the NGS Provider Contact Center on this issue. NGS will reprocess previously denied Part B claims impacted by this issue. Reprocessing for Part B claims will be initiated by NGS on Monday, 10/21/2019.

We advise both Part A and Part B providers to continue to monitor this site for additional updates.
Proposed Resolution/Fix Date

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