Common Working File Incorrectly Rejecting for Edit 538H
Part A and Part B providers in Jurisdiction K and Jurisdiction 6
Description of Issue
National Government Services is informing Part A and Part B providers of an error in CWF in the Eligibility Database, incorrectly identifying some beneficiaries as incarcerated and rejecting new claims for Edit 538H. This may also generate informational unsolicited responses (IURs) for claims that processed after the incarceration date.
National Government Services Action
As of 8/16/24, NGS is suspending any claims receiving Edit 538H until the beneficiary files are updated.
Provider Action
No provider action is indicated.
Proposed Resolution/Fix
CMS is researching this issue to determine how to correct the incarceration date for impacted beneficiaries and pay the rejected claims in error. As of 8/16/2024, any claims receiving Edit 538H will be suspended until the beneficiary files are updated. Update 11/11/2024: Effected beneficiary files are updated, any claims rejected in error were adjusted.