Last Modified: 1/2/2019 Location: FL, PR, USVI Business: Part A
Claims overlap FAQs
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/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 providers/facilities for resolution. In addition, First Coast will work with other Medicare administrative contractors (MACs) when the overlapping claim is processed by another 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 First Coast’s claims department, at 904-361-0784
Note: 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 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, status will be provided by explaining the reason on a copy of the request form. If you have not received a response within 30 days of faxing the form, submit a follow up request.
Source: CMS internet-only-manual (IOM), publication 100-04, Chapter 27 , sections 50-50.3
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