Current processing issues for Part A and Part B

December 5, 2025

The table below provides an at-a-glance look at processing issues being worked currently or resolved recently.

Current status	Last updated	Line of business	Issue	Resolution	Provider action
Open	8/21/25	Part A	Critical access hospitals (CAHs) professional claims line-item date of service (LIDOS) with revenue codes 096X, 097X and 098X are being denied (status D) for not having physician reassignments on file	CMS has instructed the MACs to temporarily deactivate reason codes 31006 and 31007. CAHs claims that denied with these reason codes will be reprocessed.	Providers should take this opportunity to review their enrollment records and submit physician reassignment applications if necessary. Individual practitioners must complete and submit the CMS-855I form to reassign their billing rights to the CAH. The CAH must forward a copy of the CMS-855I to the Part B MAC. The practitioner must sign an attestation that clearly states the practitioner will not bill the Part B MAC for any services rendered at the CAH once reassigned to the CAH. The attestation will remain with the CAH.
Closed	9/30/25	Part A	Claims for FQHC and RHC provider types are incorrectly receiving reason code C7252 for Skilled Nursing Facility (SNF) Consolidated Billing (CB) rules.	The Common Working File (CWF) has identified the issue and has developed a correction that is scheduled to be installed on October 6, 2025.	Providers do not need to take any action. The claims will be automatically identified and reprocessed. We will post additional information when the claims have all been initiated for adjustments. Update 11/13/25: All claims have been adjusted.
Open	11/11/25	Part B	We have identified an issue with conflicting Medicare Advantage (MA) plan enrollment between the HIPAA eligibility transition system (HETS) and the claims processing system causing claim denials.	We will start to hold claims from denying for MA plan enrollment. Once the resolution has been implemented, we will adjust impacted claims.	No provider action required. Once the resolution has been implemented, we will adjust impacted claims.
Open	11/21/25	Part B	We have identified an issue as a result of PTP edits implemented, October 1, 2025, for CPT code 90480. Providers are receiving denials when billing claims for COVID and other vaccines provided on the same day in error.	Claims denied in error will be adjusted.	No provider action required. Claims denied in error will be adjusted.
Open	12/04/25	Part B	We have identified an issue with overpayment initial request letters dated December 1, 2025 – December 10, 2025, indicating accounts receivables mentioning this reason for overpayment were created in error and will be closed out to prevent monetary funds from being collected. Reason for overpayment: The submitted date of service and procedures have been previously paid resulting in duplicate payment made to the provider. Medicare does not pay for service authorized by the VA, and Medicare regulations prohibit payment of services paid for by another government entity.	Overpayment initial request letters for VA duplicate payments were created in error and will be closed out to prevent monetary funds from being collected.	No further action is required from providers on these accounts receivable.