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Last Modified: 2/8/2024 Location: FL, PR, USVI Business: Part B

Telephone reopening requests via the IVR

The First Coast Part B interactive voice response (IVR) allows providers/customers to request telephone reopenings on certain claims.

Features

This enhancement is designed to make your requests easier and faster to process. Requests for telephone reopenings via the IVR will process the next day.
Using this self-service feature will result in faster receipt of any applicable payments.
The hours of availability are beyond the hours of availability for a customer service representative (CSR).

Types of reopenings available via the IVR

The following types of reopening requests are not available through a CSR; you must call the IVR for the following types of requests:
Change date of service and quantity billed
Change diagnosis code
Add, delete, change modifier (except modifiers listed below)
History corrections – including entitlement, Medicare Secondary Payer, Medicare Advantage Plan change in status or update to the patients records
Change procedure code (can also change billed amount)
Change quantity billed (can also change billed amount)
Change ordering or referring provider information

Types of reopenings that cannot be performed via the IVR

Previously adjusted claims
Pending claims
Non-assigned claims
Claims for certain drug codes (listed below)

CPT®/HCPCS drug codes not allowed via the IVR
J0200
J0390
J0395
J0520
J0735
J1094
J1700
J1710
J1885
J1960
J1990
J2323
J2440
J2670
J2760
J3490
J3590
J7130
J7184
J7199
J7310
J7326
J7628
J7629
J7648
J7658
J7659
J7683
J7684
J8499
J9165
J9201
J9217
J9219
J9270
J9357
J9999
Q0144
Q2027
Q2034
Q2035
Q2036
Q2037
Q2038
Q2039
Q2045
Q2046
90654
90655
90656
90657
90658
90659
90660
90667
90668
90715
90724
90779
96549
 
 
 
Request on claims containing the following modifiers, or requests to add or change these modifiers: 21, 22, 24, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, or SG, or WU.
Deleting a 26 modifier when the place of service is equal to 21 or 22. Multicarrier System (MCS) logic will automatically re-apply the 26 modifier to the claim.

Information you must have when calling the IVR for a reopening

Provider’s National Provider Identifier (NPI), Tax Identification Number (TIN), and Provider Transaction Access Number (PTAN)
Beneficiary’s last name and first Initial
Beneficiary’s Medicare ID
Beneficiary’s date of birth
Caller’s name and 10-digit telephone number (3-digit area code and 7-digit number)
Date of service
Internal Control Number (ICN) -- can be obtained from your provider remit notice or the IVR when receiving a claim status
Item(s) or service(s) at issue
Reason for request
New/revised information

IVR takes your request -- what’s next?

IVR will confirm the request at the end of the call.
If the request is approved, you will receive a new remittance advice notice.
If the request cannot be processed, a letter will be sent advising the provider of our decision.
If the request would create an overpayment situation, the IVR will advise you to submit your request via a written redetermination form.

IVR hours of availability for telephone reopenings

The IVR is available for requests for telephone reopenings from 7:00 a.m. to 6:30 p.m. Monday through Friday, and Saturday 7:00 a.m. to 3:00 p.m. ET.
The toll-free Part B telephone number is 1-877-847-4992

Additional information

No limit to the number of calls per day.
Please have the information listed under “Information You Must Have When Calling the IVR for A Reopening” available when calling for an IVR reopening.
Additional IVR instructions are available via our IVR Part B operating guide.
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.