Accountable Care Organization Realizing Equity, Access, and Community Health Model Claims Adjusted in Error

CMS informed NGS of an issue that occurred on 7/26/2024 impacting some claims from 2021 – 2024 related to the ACO REACH Model.

CMS advised NGS, if the reprocessed claim resulted in a complete recoupment of the ACO service, the demonstration message 92 will not display on the remittance advice. NGS is working with CMS to correct the issues this has caused.

CMS shared information regarding this issue in their MLN Connects® Newsletter: September 19, 2024 which posted to our news page on that date.

Providers do not need to take any action on these claims. Impacted claims will be adjusted to allow and/or recoup funds that were paid in error to your practice. NGS will process the appropriate claim action and you will receive a remittance advice when completed which will explain the adjustment.

If a refund is due, you’ll receive a demand letter requesting the refund, the reason for the refund will be included in the demand letter.

IMPORTANT: If you are a provider affected by these adjustments, you may have received remittance advices with many withholdings (WO). The AR FCN associated with the ACO adjustments start with PI, for ex. PI123456789012345. When the adjustments were made it was the intent that a letter would be generated to explain the withholdings, provide the patient, and claim information. CMS is aware there were instances where the letter and patient information was not generated and mailed to the provider. This issue is being researched and CMS will provide the MACs with a resolution to get the letters and information to the providers.  

Please do not call the Provider Contact Center to request this as they will not be able to assist with providing the patient information.  

Revised 10/4/2024