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Last Modified: 3/1/2024 Location: PR Business: Part B

Part B interactive voice response (IVR) operating guide
1-877-847-4992

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.

Hours of operation

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 6:30 p.m., ET
Saturday 6 a.m. to 3 p.m., ET

Touchtone or speech

Providers in Florida have the option of selecting speech or touchtone when using the IVR. Touchtone is available to providers in the U.S. Virgin Islands and Puerto Rico. In order to receive the maximum results that 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 and 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 an 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 that 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).
• If the patient’s last name contains a space between two last names, callers should enter the first six letters of the ‘primary’ last name for beneficiary authentication. (Example: if the last name is “Correa Augusto” enter “CORREA” for the last name).
• 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#

Helpful tips

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 via the IVR:
• National Provider Identifier (NPI)
• Tax Identification Number (TIN)
• Provider Transaction Access Number (PTAN)
• Beneficiary Medicare ID
• Beneficiary name
• Beneficiary date of birth
• Date of service (If applicable)

Main menu -- number/option

1. Closures. hot topics, outreach events, general questions and hours of operation
2. Status and reopenings
3. Eligibility
4. Pending claims
5. Check status
6. Remittance codes/pricing
7. Enrollment information

Closures and general information - press 1

• Training and holiday closures, press 1
• Hot topics, press 2
• Provider outreach and education information, press 3
• General appeals, website and information to have when calling Medicare, press 4
• Hours of operation, press 5

Claim and correspondence/appeal status and telephone reopenings - press 2

• For claim status, press 1
Assigned claim status
Pending, finalized, denied
Date of service
Amount submitted
Processed date
Deductible
Payment amount
Payment date
Check number
Internal Control Number (ICN)
Supplemental insurance (Forwarded or not)
Non - assigned claims
Processed date
Amount submitted
Payment date
• Additional claim detail
*This menu is offered after the information above has been voiced.
• Procedure code
• Date of service
• Billed amount and allowed amount for each procedure code
• Denial message
• For correspondence and appeal status, press 2
• IVR will voice date correspondence or appeal was completed and the Correspondence Control Number (CCN)
• To request a telephone reopening of a claim, press 3
• The IVR will prompt for individual detail line adjustments, press 1. To request to have an entire claim reprocessed without making any changes, press 2. If option 1 is pressed, the following individual detail line adjustment types are offered:
• Changes to date of service, press 1
• To add, delete, or change a modifier, press 2
• To change a diagnosis, press 3
Note: This option is only for the primary diagnosis for a procedure.
• To change a procedure code and billed amount (if desired), press 4
• To change the quantity billed and billed amount (if desired), press 5
• To update the Ordering or Referring provider information, press 6

Eligibility, Medicare Secondary Payer, Medicare Advantage, deductible and physical and occupational therapy information - press 3**

• For current eligibility information, press 1
• Entitlement date
• Termination date (if applicable)
• *Part B deductible
• Current Year deductible
• Previous Year deductible
• Deductible information not provided for patients enrolled as a Qualified Medicare Beneficiary (QMB)
• Medicare Advantage information
• Medicare is primary or secondary
If a Medicare Advantage plan is found, you can press 1 for more information.
• The IVR will give the Medicare Advantage Plan number
• Plan type
• Plan name, address and telephone number
• Effective date and termination date of policy
If Medicare is secondary, press 1 for MSP details
• Type of primary insurance
• Effective and termination date for all valid Insurers
• (Current or previous date of service)
• For eligibility for a previous date of service, press 2
• For physical and occupational therapy information, press 3
• For Medicare Advantage Plan information, press 4
• enters a specific Medicare Advantage plan number to receive specific information such as:
• Plan Type
• Plan name, address, and telephone number
Note: After primary eligibility information is obtained, the IVR will prompt the caller to press an option for additional eligibility.
**Note: Certain provider specialty types may only receive limited eligibility information.

Sub menu for additional eligibility

• Skilled nursing facility (press 3)
• SNF effective date
• Termination date (if Applicable)
• Servicing provider name, address, and telephone number
• Hospice (press 4)
• Hospice effective date
• Termination date (if applicable)
• Servicing provider name, address, and telephone number
• Home health (press 5)
• Home health effective date
• Termination date (if applicable)
• Servicing provider name, address, and telephone number

Pending claims information and month-to-date or year-to-date dollar amount on file - press 4

• For current number of pending claims and their combined billed amount, press 1
• For month or year-to-date number of claims processed and paid amounts, press 2
• For the previous year paid amount, press 3

Check information - press 5

• For the last three checks, press 1
• Issue Date
• Check Number
• Check Amount (if applicable)
• Check Status (outstanding/cleared)
• For check history by issue date, press 2
• Issue Date
• Check Number
• Check Amount (if applicable)
• Check Status (outstanding/cleared)
• For check history by check number, press 3
• Issue Date
• Check Number
• Check Amount (if applicable)
• Check Status (outstanding/cleared)

Definitions of remittance codes and pricing for procedure codes - press 6

• For remittance code information, press 1
• For pricing of a procedure code, press 2

Enrollment information - press 7

• 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

Repeat menu - press 8

This option returns callers to the main menu.

End call - press 9

This option ends the call in the IVR.

Additional information

Customer service representatives -- Medicare Part B
8 a.m.-4 p.m. ET Monday through Friday, for providers in Puerto Rico, excluding holiday closings.
Toll-Free Telephone Number: 1-877-715-1921
Speech and Hearing Impaired: 1-888-216-8261
Training hours
The First Coast Medicare Part B provider call centers are typically closed for staff training purposes on Thursdays from 2 p.m. to 4 p.m., ET.
General Written inquiries -- Medicare Part B issues
Puerto Rico
Email address: AskPuertoRicoB@fcso.com
Website links
For additional information, visit the Centers for Medicare & Medicaid Services’ (CMS) website at https://www.cms.gov/Medicare/Medicare.html external link
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.