Last Modified: 11/26/2019
Location: FL, PR, USVI
Business: Part A, Part B
When a Medicare administrative contractor (MAC) cannot process a claim because another MAC has processed and posted a prior claim to the common working file (CWF), the two contractors must work together to resolve the issue created by the conflicting claim.
The contractor requiring assistance (i.e., requesting contractor) must submit a formal request to the contractor that posted the prior claim (i.e., assisting contractor), and the issue must be resolved in accordance with guidelines specified by the Medicare Claims Processing Manual - Chapter 27
, Sections 50-50.3
If you need to request assistance from First Coast Service Options (First Coast) to resolve an overlapping claim, please complete, print, and fax the Request for Assistance form
and supporting documentation to First Coast’s claims department: 904-361-0784.
Please use a separate form for each request to enable First Coast to return each claim as it is completed instead of holding claims until all claims on a request have been completed.
If you have not received a response within 30 calendar days of the submission of your request, please submit a follow-up request.
Upon receipt of the “Request for Assistance Form,” First Coast will take appropriate action and will notify the requesting contractor of the action taken within 30 calendar days of receipt of the request. If First Coast cannot complete the action within 30 days, it will provide a status reply explaining the reasons on a copy of the request form.
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.