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Appeals news

Redetermination feedback
Modified: 9/12/2021
Find the appropriate forms to appeal claim decisions.
Modified: 8/16/2021
Before you request a redetermination on a denied claim, review these tips to avert delays in payment and save some valuable time.
Modified: 8/16/2021
Use this tool for confirmation that appeal requests have been received by First Coast Service Options
Modified: 8/16/2021
First Coast Service Options Inc (First Coast) offers multiple ways of appealing a claim denial. The most efficient way to do so is through First Coast’s portal, SPOT.
Modified: 8/16/2021
Using First Coast web tools to manage the claim appeal process will save you time and money.
Now that you reviewed those steps and concluded that your claims are eligible for redetermination, how do you proceed? First Coast offers the following tips for managing the appeal process.
Modified: 8/16/2021
These are questions the contact center regularly receives regarding general information about appeals, overpayment appeals, reopenings and the SPOT with their answers.
Modified: 8/16/2021
View the appropriate form to dispute an existing overpayment. If you have not received a demand letter, see the appropriate overpayment refund form.
Modified: 8/16/2021
Please review this article for information on redeterminations for HCPCS code G0463 when performed by hospital outpatient clinics for visits furnished in excepted off-campus provider-based departments of hospitals.
Modified: 7/31/2021
Find appeals related contact information.
Modified: 5/12/2021
Find the appropriate forms to report or dispute an overpayment.
Modified: 5/8/2021
Find appeals related contact information.
Modified: 1/1/2021
Find information regarding the appeals process -- levels, forms, training, FAQs, and how to appeal Medicare coverage and payment decisions.
Modified: 12/18/2020
The "history correction" feature is now available in the Claim Reopening Gateway, a free, web-based application that allows for automated submission of claim corrections with no enrollment process.
Modified: 11/4/2020
Avoid the appeals process by making minor claim corrections through a clerical reopening request for Part B claims.
Modified: 10/28/2020
This fact sheet provides information about each level of appeal and describes how the Medicare appeals process applies to providers and participating physicians and suppliers. Non-participating physicians and suppliers have limited appeal rights.
Modified: 10/28/2020
The time limit for filing a request for redetermination may be extended in certain situations. Good cause may be found when the record clearly shows, or the provider, physician or other supplier alleges and the record does not negate, that the delay in filing was due to one of the covered reasons.
Modified: 10/7/2020
This article provides notification of the 2021 dollar amount in controversy required to sustain appeal rights for an administrative law judge (ALJ) hearing or federal district court review.
Modified: 10/4/2020
This article provides notification of the 2020 dollar amount in controversy required to sustain appeal rights for an administrative law judge (ALJ) hearing or Federal District Court review.
Modified: 9/13/2020
The Centers for Medicare & Medicaid Services has started accepting expressions of interest for a limited settlement agreement option for appellants with fewer than 500 appeals pending at the Office of Medicare Hearing and Appeals and the Medicare Appeals Council at the Departmental Appeals Board.
Modified: 8/21/2020
Claims that are returned as unprocessable cannot be appealed. So what do you do with them? An unprocessable claim is one that is filed with incomplete and/or invalid information. This article provides resources for you to diagnose unprocessable claims and resubmit them with correct information to get them paid.
Modified: 5/13/2020
Find appeals related contact information.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
Part B