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CGS Update on Claims Processed with Incorrect MUE Values


The following message is a list-serve message from CGS Administrators, DME MAC Jurisdiction B:

As communicated on 9/30/20, CGS is aware of a claim processing issue which has caused a number of claims to be processed incorrectly, denying with Reason Code CO-151, due to an issue with the Medically Unlikely Edit (MUE) files. We recently became aware that in addition to the impact to initial claims, there is also an impact to claim adjustments that were initiated or in process on 9/23/20 or 9/24/20. These adjustments may have been the result of a reopenings request, appeals request, CARES Act adjustment, or any other reason that a claim would normally be adjusted. The affected adjustments have also denied with Reason Code CO-151.

In the case of many of these adjustments, because the initial claim had been paid, the now denied adjustment has automatically created an overpayment situation. You may incorrectly receive overpayment demand letters or immediate offsets regarding these claims. Note that not all CO-151 denials were processed incorrectly.

CGS is working on a solution to resolve this issue as quickly as possible, although we cannot currently provide a timeframe for when all the claims and adjustments will be corrected. At this time, you do not need to take any action regarding the affected claims, adjustments, or overpayments.

Update: CGS has completed all the first phase Jurisdiction B adjustments. The last 3 digits of the first phase adjustment claim numbers will most commonly end in 002.

Please continue to monitor our ListServ and our Claim Payment Alerts page for additional information, which we will provide as soon as it is available.

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