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IVR operating guide - Puerto Rico Part A
Last Modified: 9/11/2020
Location: PR
Business: Part A
First Coast Service Options, Inc. (First Coast) strives to provide you with the most up to date automation features as possible. The IVR operating guide will help to increase your knowledge of the technology and services we offer our providers. You may also find our
IVR Quick Reference Guide 
helpful.
IVR unit hours of availability
The IVR is available 24 hours a day, 7 days a week, except for regularly scheduled maintenance. However, specific claim and/or eligibility information is available during the following times, with the exception of Holidays:
Monday-Friday 7 a.m. to 7 p.m., ET
Saturday 6 a.m. to 3 p.m., ET
All callers have the option of selecting speech or touchtone when using the IVR. In order to receive maximum, results you deserve when speaking we offer the following tips:
• Use a telephone with a handset or headset
• Avoid using a speakerphone or cell phone
• Avoid calling from areas with loud background noise
• Speak the requested information clearly in a quiet environment
*When using the speech recognition option on the IVR, and keying the date is required (date of service, date of birth, etc.), the date must be given in 8-digit format (mm/dd/yyyy).
In the event the system does not accept the spoken information, touch-tone is always available. In order to receive the maximum results you deserve when using touch-tone we offer the following tips:
• Dates should be entered in the following format (mm/dd/yy)
• To signal you are entering an alpha suffix or letter, press the * key
• Press the key that includes the letter, then the corresponding number that denotes where the letter is located on the number key.
• If the patient’s last name contains a suffix, space, hyphen, or apostrophe, enter up to six letters before the special character. Stop entering once you reach the special character up to a maximum of six letters, whichever comes first. (Example: if the last name is “De-Amaro” enter only DE).
• After all letters desired have been keyed, press the pound (#) sign to end your entry.
Use the numbers on the telephone keypad that corresponds to the patient or provider number:
A = *21#
Q =*72#
R = *73#
Z = *94#
As a result of the Health Insurance Portability and Accountability Act (HIPAA), we are required to protect the privacy of all individuals. You must have the following information available for authentication to access patient eligibility, deductible and claims information from the IVR:
• National Provider Identifier (NPI)
• Provider Transaction Access Number (PTAN)
• Beneficiary Medicare ID
• Beneficiary name
• Beneficiary date of birth
• Date of service (if applicable)
1. Closures. hot topics, outreach events, general questions and hours of operation
2. Claim status
3. Check status
4. Publication information
5. Eligibility
6. Remittance codes
7. Enrollment information
• Training and holiday closures, press 1
• Hot topics, press 2
• Provider outreach and education information, press 3
• General MSP and appeals information, press 4
• Hours of operation, press 5
• For Claim status, press 1
The IVR voices the following information:
• Type of bill
• Amount submitted
• Date claim received
• Reimbursement amount
• Document Control Number (DCN)
• Remittance advice date
The IVR voices the following information when it is returned to the provider:
• Date claim received
• Amount submitted
• Date returned
• Document Control Number (DCN)
• Reason code
• Reason for return
The IVR voices the following on pending claims:
• Date claim received
• Amount submitted
• Document Control Number
• To obtain the amount of your last check, press 1
• For information on an individual check by check date, press 2
• For information on your last three checks, press 3
• For information on Medicare seminars, press 1
• For information on CMS publications, press 2
• For information on Medicare Part A publications, press 3
• For current eligibility information, press 1
• Part A and B entitlement date
• Part A and B termination date (if applicable)
• *Part B deductible information
• Current Year deductible
• Previous Year deductible
• Deductible information not provided for patients enrolled as a Qualified Medicare Beneficiary (QMB)
• Full hospital days remaining
• Hospital co insurance days remaining
• Full skilled nursing facility days
• Skilled nursing facility co insurance days
• Lifetime reserve days remaining
• Lifetime psychiatric days remaining
• Last billing date
• Medicare Advantage information
• Medicare is primary or secondary
If Medicare Advantage Plan is found, you can press 1 for more information.
• The IVR will give the Medicare Advantage number
• Plan type
• Plan name
• Effective dates and termination date of policy
• Address of Medicare Advantage servicing provider
If Medicare is secondary, press 1 for additional MSP details
• Type of primary insurance
• Effective and termination date for all valid insurers for either current or previous date of service.
• For eligibility for a previous date of service, press 2
• For physical and occupational therapy Information, press 3
• Medicare Advantage (formerly known as HMO) information - Press 4
• enters a specific Medicare Advantage plan number to receive specific information such as:
• Plan name
• Type of plan
• Address of plan provider
Note: After primary eligibility information is obtained, the IVR will prompt the caller to press an option for additional eligibility.
• Hospice
• Hospice effective date
• Termination date (if applicable)
• Servicing provider number
• Home health
• Home health effective date
• Termination date (if applicable)
• Servicing provider number
• Skilled nursing facility
• SNF effective date
• Termination date (if applicable)
• Servicing provider number
• For remittance code information, press 1
• For status of an enrollment application, press 1
• For a summary of applications and when to use them, press 2
• For a summary of documents required for certain specialties, press 3
• For mailing address and PECOS internet enrollment information, press 4
• For open enrollment and participation in Medicare information, press 5
• For a summary of enrollment information available on our website, press 6
This option returns callers to the main menu
This option ends the call in the IVR.
Customer service representatives—Medicare Part A
8 a.m.-4 p.m. Monday through Friday, AT for providers in Puerto Rico, excluding holiday closings.
Toll-free telephone number: 1-877-908-8433
Speech and hearing impaired: 1-888-216-8261
Training hours
The First Coast Medicare Part A provider call centers are typically closed for staff training purposes on Thursday from 2 p.m. to 4 p.m. AT in Puerto Rico.
General written inquiries -- Medicare Part A issues
Puerto Rico
Website links
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.
