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 Secure Provider Online Tool (SPOT).
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.
These are questions the contact center regularly receives regarding general information about appeals, overpayment appeals, reopenings and the SPOT with their answers.
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.
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.
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.
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.
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.
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.
Completion of the overpayment redetermination request for a Medicare Part B claim form and receipt in the appropriate mailbox is critical to correct processing of an overpayment redetermination request.
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.
