We have received inquiries from providers seeking to find out if the payments have been impacted by the government shutdown. This has not impacted payments to providers at all.

There have been some payments that are slower in coming this month than what providers may be used to seeing. We take our mission of adjudicating claims and issuing payments to provider very seriously and as a result we strive to pay most claims within the timeframe of the claims payment floor. However, please keep in mind this is a minimum amount of days before a Medicare Administrative Contractor (MAC) may make payment. We cannot release any payment to a provider for 14 days for electronic claims or 27 days for paper. Again, this is a minimum and the Centers for Medicare & Medicaid Services (CMS) regulations for processing claims is actually 30 days for 95% of clean claims to be processed.

With that said, there has been some delay in finalizing claims due to the January Quarterly Release for Medicare. As with each quarter, each MAC is advised by CMS to hold claims to make sure the release is working properly. For this January release, CMS has just recently indicated that claims may begin to be released. We are releasing those claims that have been processed and awaiting finalization through the Common Working File (CWF) at this time.  You will, if you have not already, begin to see these claims start to come through your revenue cycle. Please be aware that customer care will not be able to expedite this process and providers will need to wait while we clear these claims out based on the order in which they were received. If you would like to check to see if your claim is actually received and pending for final adjudication, then you may wish to check the Interactive Voice Response (IVR) or NGSConnex for that claim status.

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