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Claim Payment Alert from Jurisdiction B DME MAC

Claims Processed with Incorrect MUE Values 9/23/20–9/24/20


CGS is aware of a claim payment issue in which some claims may have applied Medically Unlikely Edit (MUE) values incorrectly. The MUE files were incorrect in our system on 9/23/20–9/24/20, affecting claims that were in process on those dates (and continued to affect claims that began processing on those dates, even if the claim completion date was after the file was corrected). Claims may have paid or denied in error as a result. We have identified and corrected the MUE files to prevent future claims from processing incorrectly. CGS is currently making every effort to identify and adjust the affected claims—if your claims were affected by this issue, you do not need to take any action at this time.

For additional information and status about this issue, refer to our Claim Payment Alerts page.

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