Check patient eligibility prior to submitting claims to prevent denials

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Home ► Billing news ► Check patient eligibility prior to submitting claims to prevent denials

Last Modified: 10/3/2022 Location: FL, PR, USVI Business: Part B

Check patient eligibility prior to submitting claims to prevent denials

First Coast wants to ensure your claims process quickly and correctly. We’re seeing Part B claims denying due to the patient’s status showing as inpatient in a facility for COVID-19 laboratory testing. These denials communicate that the claims should be submitted under Part A.

To prevent these denials, we recommend that you check the patient’s status prior to submitting the claim to determine if the claim should be submitted under Part A instead of Part B. In addition to obtaining the patient’s effective date for Part A and B, you should also obtain any applicable spells of illness for the patient. This includes hospice, home health, skilled nursing facility, and hospital stays.

You can quickly check patient status and eligibility using the interactive voice response (IVR) system or our free internet portal, SPOT.

Checking patient status: IVR

To obtain eligibility from the IVR, select option 3 from the main menu. After providing primary eligibility information, the IVR will prompt you to press an option for additional eligibility information. The IVR will then provide the following information:

• Hospice

• Hospice effective date

• Termination date (if applicable)

• Servicing provider number

• Home health

• Home health effective date

• Termination date (if applicable)

• Servicing provider number

• Skilled nursing facility (SNF)

• SNF effective date

• Termination date (if Applicable)

• Servicing provider number

For more information and to locate the provider information using the provider number from the IVR, please visit the IVR Resources webpage.

Checking patient status: SPOT

The SPOT provides the following information:

• Hospital stay

• Start date

• End date

• Billing NPI

• Hospice

• Hospice effective date

• Termination date (if applicable)

• Servicing provider number

• Home health

• Home health start date

• End date (if applicable)

• NPI

• SNF

• Start date

• End date

• Billing NPI

For more information on registration and using SPOT to access patient eligibility, please review The SPOT: User Guide pdf file

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