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Last Modified: 1/20/2012
Location: FL, PR, USVI
Business: Part A, Part B
Provider inquiry checklist
Be prepared when contacting First Coast Service Options Inc. (FCSO)
In accordance with the Health Insurance Portability & Accountability Act (HIPAA), FCSO is entrusted to secure protected health information (PHI) of all individuals. Access to patient and claims information requires an authentication process.
Use the following checklist to ensure you have the authentication information required (right column) for the specific type of inquiry indicated (left column). Separate checklists have been provided for inquiries performed through our Interactive Voice Response (IVR) system and for those made through our provider contact center, whether in Florida (FL), Puerto Rico (PR), or the U.S. Virgin Islands (USVI).
IVR Inquiries
Part A (FL, PR, USVI) -- 1-877-602-8816
Part B (FL, PR, USVI) -- 1-877-847-4992
IVR Inquiry type |
Information required |
|---|---|
• For all inquiries identified below, the National Provider Identifier (NPI), Provider Transaction Access Number (PTAN) and the last 5 digits of the Provider’s Tax Identification Number (TIN) are required. | |
Claim status |
• Patient’s last name -- first 6 letters • Patient’s first initial • Patient’s Health Insurance Claim (HIC) number (Medicare number) • Date of service (DOS) |
Clerical reopening (claim adjustment) -- single line (Part B only) Click here for additional details • Change date(s) of service (DOS) • Add, change, delete modifier(s) (Exceptions: modifiers 21, 22, 51, 53, 56, 62, 66, 99, CC, GY, GZ, SG, or WU) • Note: Application of GV or GW modifiers (hospice) can be applied to an entire claim • Change diagnosis • Entitlement reopenings • Change in entitlement effective dates • Update regarding patient’s primary insurance -- Medicare secondary payer (MSP) situations • Medicare Advantage (MA) plan involvement update |
• Caller’s name • Caller’s 10-digit telephone number • Patient’s HIC number (Medicare number) • Patient’s first initial • Patient’s last name -- first 6 letters • Patient’s date of birth (DOB) • Inventory Control Number (ICN) of claim requested • Date of service (DOS) • Item(s) or service(s) at issue • New or revised information |
Patient’s eligibility |
• Patient’s last name -- first 6 letters • Patient’s first initial • Patient’s HIC number (Medicare number) • Patient’s date of birth (DOB) |
Provider enrollment application status Click here to look up your enrollment status |
• Correspondence Control Number (CCN) -- 15 digits |
Click here to access the IVR operating guide for FL/USVI; Click here for the IVR operating guide for PR.
Provider Contact Center
Part A: FL, USVI -- 1-888-664-4112 PR -- 1-877-908-8433
Part B: FL, USVI -- 1-866-454-9007 PR -- 1-877-715-1921
Customer service inquiry type |
Information required |
|---|---|
• For all inquiries identified below, the NPI, PTAN and the last 5 digits of the Provider’s Tax Identification Number (TIN) are required. | |
Appeals request -- status |
• Patient’s last name • Patient’s first name or initial • Patient’s HIC number (Medicare number) |
Claim information (excluding status) | |
Clerical reopening -- single line (Part B only) Speak to CSR for reopening previously adjusted claims. • Note: Reopenings cannot be performed on: • Pending claims • Non-assigned claims • Drug and drug administration codes • Requests related to modifiers 21, 22, 51, 53, 56, 62, 66, 99, CC, GY, GZ, SG, or WU |
• Patient’s HIC number (Medicare number) • Patient’s last name • Patient’s first name/initial • Patient’s date of birth (DOB) • Date of service (DOS) • Item(s) or service(s) at issue • New/revised information |
Clerical reopening -- multiple lines (Part B only) CSRs may only assist on certain claims with more than a single line being adjusted or when changes apply to an entire multiple-line claim. |
• Patient’s last name • Patient’s first name/initial • Patient’s HIC number (Medicare number) • Date of service (DOS) • Item(s) or service(s) at issue • New/revised information |
Patient’s eligibility issue (if not available through IVR) |
• Patient’s last name • Patient’s first name/initial • Patient’s HIC number (Medicare number) • Patient’s date of birth (DOB) |
Provider enrollment issue** (excluding status) **Only contact person on application may call to discuss issue. Click here to look up your enrollment status |
• Correspondence Control Number (CCN) -- 15 digits • Copy of application and any correspondence sent |
Source: CMS IOM Pub. 100-09, Chapter 3, Section 30.1 and 30.5
