How contractors may request assistance with overlapping claims

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Home ► Claim submission guidelines ► How contractors may request assistance with overlapping claims

Last Modified: 11/6/2020 Location: FL, PR, USVI Business: Part A, Part B

How contractors may request assistance with overlapping claims

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 external pdf file

Complete and submit a ‘Request for Assistance’ form

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 pdf file

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.

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