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Last Modified: 8/5/2022 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.
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.