January 2021 Quarterly Release Temporary Hold

Each quarter, the Fiscal Intermediary Shared System (FISS) is updated to include new logic for claims processing, pricing, etc.

When the release is installed, Palmetto GBA places a temporary hold to ensure the release is installed properly. During this time, claims with dates of service of January 1, 2021, or later will be held in the status/location listed below and may be released before or on January 14, 2021, to continue processing.

Reason Code

Location Status

Description

36452

SMHOSP

Hospice

37230

SMHOME

Home Health PPS Claims

WW999

SMFISS

Holds All Claims

This process does not apply to home health Requests for Accelerated Payments (RAPs) or hospice Notices of Election (NOEs).

Providers should be reminded that Medicare claims processed by the 30th day from claim receipt are considered timely. Beginning on the 31st day from receipt, interest will be applied to clean claims that have not been processed. A “clean” claim is one that does not require the carrier or FI to investigate or develop external to their Medicare operation on a prepayment basis.