Last Modified: 5/15/2020
Location: FL, PR, USVI
Business: Part A
Q: I have contacted the overlapping facility numerous times and have asked them to correct their claim, but the claim has not been corrected. What steps can be taken to get the other facility’s claim updated?
A: While providers and facilities are required and expected to work together to resolve the billing issue, providers may occasionally require assistance from the Medicare Administrator Contractor (MAC). In that case, First Coast Service Options (First Coast) will work with both the provider and the facility for resolution. In addition, when the overlapping claim is processed by another MAC, First Coast will work with that other MAC.
Complete and submit ‘Request for Assistance Form’
You may request assistance from First Coast to resolve your overlapping claims. Please complete, print and fax:
• Supporting documentation must be included with your request
• Fax to the First Coast Claims Department, at 904-361-0784
Note: Use a separate form for each request. This will enable First Coast to return each claim as it is completed, instead of holding claims until all claims on the request have been completed.
Upon receipt of the ‘Request for Assistance Form’, First Coast will take appropriate action within 30 calendar days. When First Coast is unable to complete the request within 30 days, we will provide a status and the reason for the delay on a copy of the request form. If you do not receive a status or response within 30 days of faxing the form, please submit a follow up request.
Source: CMS internet-only-manual (IOM), publication 100-04, Chapter 27
, sections 50-50.3
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