Last Modified: 8/27/2020
Location: FL, PR, USVI
Business: Part A, Part B
Q. What is a general inquiry?
A. A general inquiry is a written or emailed inquiry asking a question, which is general in nature. It could also be a redetermination request that did not meet the requirements of a redetermination.
Q. How long will it take to get a response to my written inquiry?
A. The general inquiries area has 45 business days to respond to an inquiry on a first in, first out basis. Redeterminations and other types of inquiries have different timeframes.
Q. If I send my inquiry via fax, will you reply via fax?
A. To protect protected health information and personally identifiable information, we do not respond to inquiries via fax.
Q. How do I make sure that I don't receive a letter advising privacy requirements are missing?
A. For claim, eligibility or provider specific questions, submit your Provider Transaction Access Number (PTAN); National Provider Identifier (NPI); the last five digits of your Taxpayer Identification Number (TIN); provider’s name; provider’s address; the beneficiary’s name (exactly as it appears on their Medicare card); Medicare Beneficiary Identifier (MBI); and date of birth (if it is an eligibility related question).
Q. How can I verify if you have a claim on file, instead of having to send in an appeal?
A. You can verify if a claim is on file through the interactive voice response (IVR) or through the Secure Provider Online Tool (SPOT).
Q. What telephone number can beneficiaries or their representatives call to obtain Medicare information?
A. Beneficiaries and/or their representatives may obtain Medicare information by calling 800-MEDICARE (800-633-4227).
Q. How many inquiries will a Provider Contact Center representative answer per call?
A. The representatives will answer at least three inquiries before asking you to call back if you have additional questions.
Q. What is a “dark day”?
. A “dark day” means that certain systems are pulled offline, usually to install updates. You can normally count on a dark day the day before the weekend install of each quarterly release. For example, dark days for the April 2018 quarterly release we
re Friday, March 30, 2018, through Sunday, April 1, 2018.
Q. Can I still get eligibility information on a dark day?
Since most of the eligibility information available through the IVR is fed by the HIPAA Eligibility Transaction System (HETS
, you can still access the IVR to get beneficiary entitlement, Medicare secondary payer (MSP), HMO, hospice, home health episode, etc.
Q. When authenticating, am I able to use the number zero (0) interchangeable with the letter O?
A. No. The number zero and the letter O cannot be used interchangeably. For example, if the provider’s PTAN is 12340 you must state zero not the letter O.
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.