Last Modified: 6/8/2018 Location: FL, PR, USVI Business: Part A, Part B
Customer service representatives cannot provide claim status via the toll-free service line
Medicare guidelines, specifically, the internet-only manual (IOM) Publication, 100-09 Chapter 6 Section 50.1 require that providers call the interactive voice response system (IVR) to obtain claim status. Service associates responding to calls via our toll-free service line are not allowed to provide claim status. To do so would be in violation of Medicare service guidelines.
First Coast Service Options’ (First Coast’s) customer service representatives (CSRs) continue to receive a large volume of calls from providers asking for claim status. In the majority of cases the calls are coming from entities representing Medicare providers. Because many providers have chosen to outsource their claims monitoring activities, they may not be aware that the entities representing them are calling the toll-free CSR service line for status of claims instead of using the IVR.
When claim status calls are made to the toll-free CSR service line, it slows our response time for other calls coming into our call center because service associates are attempting to explain to customers that status cannot be released via the general inquiry service line. It is the responsibility of Medicare providers to notify the entities representing them that claim status inquiries must be made via the IVR or our internet portal, the SPOT. See https://medicare.fcso.com/Landing/256747.asp
Source: CMS IOM Pub. 100-09, Chapter 6, Section 50.1
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