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Last Modified: 10/28/2022 Location: FL, PR, USVI Business: Part A, Part B

What if I do not agree with First Coast’s determination? Does the TPE process change the current appeal process in place for Medicare providers?

Q: What if I do not agree with First Coast’s determination? Does the TPE process change the current appeal process in place for Medicare providers?
A: The process for appealing claim determinations remains the same. If you disagree with the determinations made by the medical review department, your next level of appeal is a redetermination. A redetermination is an independent re-examination of a claim. If you wish to appeal, this must be done within 120 days from the date of the demand letter. Please note that First Coast takes into consideration all appeals overturned prior to initiating a subsequent TPE round of review.
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.