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Telephone reopening requests via the IVR
Last Modified: 4/24/2024
Location: FL, PR, USVI
Business: Part B
The First Coast Part B interactive voice response (IVR) allows providers/customers to request telephone reopenings on certain claims.
• 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).
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
• Previously adjusted claims
• Pending claims
• Non-assigned claims
• Claims for certain drug codes (listed below)
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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 |
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• 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.
• 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 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.
• 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
• 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.
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.