03/01/2017

Claims Processing Issues: V8031

The National Association for Home Care & Hospice (NAHC) has been in contact with the Centers for Medicare & Medicaid Services (CMS) regarding the claims processing issue where claims are being suspended for reason codes V8030 for NGS, V8031 for Palmetto, and E0419, V8029, V8030, and V8031 for CGS. CMS has informed NAHC that it plans to install a “utility” on March 6 that will begin to clear the back log of suspended claims. Although claims will continue to suspend until the April system fix is installed, the “utility” will continue to work on processing suspended claims.

The number of claims suspended is increasing and represents a significant amount of revenue that is being tied up, particularly for CGS providers. And although there has been some manual processing of these claims, this process is slow and laborious, and does not yield much relief for providers. CMS recognizes that home health agencies cannot wait until April, when the fix is planned to be installed, to have claims currently suspended to process. (National Association for Homecare and Hospice)