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Effective Date Change for Bypass of Common Working File (CWF) Edits on Inpatient Ancillary 12X Claims for Part A Benefits Exhaust

The purpose of this change request (CR) is to correct the effective date for the bypass of CWF editing on inpatient Part B ancillary 12X claims previously added with CR 13810. The bypass allows ancillary claims to be processed for payment consideration when Part A benefits are exhausted during the inlier portion of an inpatient stay that has exceeded a cost outlier threshold. This CR changes the effective date of this logic to apply to claims processed on or after January 5, 2026, allowing the Medicare Administrative Contractors (MACs) to process resubmitted claims that were previously rejected in error. This CR also includes an update to allow the MACs the functionality to override CWF Crossover Reject C7050.

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Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: July 31, 2025

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.