Payment issue affecting end stage renal dialysis services on type of bill 72X

LOB

Part A

Issue

Various processing and payment issues have occurred on ESRD Treatment Choices (ETC) model claims, identified by demo code 94, starting with date of service January 1, 2022, for claims received before September 27, 2024. The claims were finalized but may have incorrect payment amounts resulting in overpayments as well as underpayments.

Resolution

Corrections to the issues were installed into the Fiscal Intermediary Shared System (FISS) on September 27, 2024. Claims processed prior to that date will be mass adjusted. The adjustments will be suspended to status location, S/M2784, and released in smaller volumes per day to prevent any system issues.

Status

Closed

Provider action

Providers don't need to take any action on these claims.

Current processing issues

Here is a link to a table of current processing issues for Part A and Part B.