Last Modified: 11/6/2017 Location: FL, PR, USVI Business: Part A, Part B
Fax machine settings can lead to "timed-out" claim denials
First Coast Service Options (First Coast) is experiencing an increase in claim denials due to providers not responding timely to additional development requests (ADRs). If you have received this type of claim denial even though you responded via fax by the due date, your fax machine settings may be causing these unnecessary denials. First Coast identified this as an issue particularly for providers faxing documentation to multiple ADRs during the same time period.
When documentation is required to continue processing claims, an ADR letter is sent and the provider has 45 days to respond. If the records are not received timely, the claim automatically denies on day 46. The messages for these timed-out claim denials include:
• Part A: Reason codes 56900 or 39721
• Part B: Claim adjustment reason code (CARC) CO 50 with remittance advice remark code (RARC) M127
• Part B: CARC CO 226 with RARC N517
Check your fax settings
If you have received these types of denials but have responded by fax timely, the issue may be the batch setting for your fax machine or fax system. If the batch setting is active, transmissions will batch, or bundle, all documents sent to the same destination number within a specific time frame as one transmission. This occurs even if you scan and receive confirmation pages separately for each fax transmission because your fax machine/system holds the records in its memory for a period of time.
First Coast's automated imaging process receives batch transmissions as only one submission. This means that only the first claim of the batch submission is controlled and received as timely. Documents for other ADRs included in the batched submission are not controlled, which causes the claims to eventually time out and deny.
Avoid using batch transmissions when responding to ADRs
First Coast must receive the documents for each ADR separately to be matched to the appropriate claim timely; therefore, providers should ensure that batch transmissions are not occurring when faxing. Some fax machine models allow the # key to be pressed at the end of your document(s) scanning for each ADR, which signals the machine to finish the transmission before starting the next one. However, every machine is different, so check the user manual or contact the manufacturer's customer service for assistance on deactivating the batch setting. At the end of this article, we provide examples with technical details for certain types of fax systems or manufacturers.
Please DO NOT contact First Coast’s Customer Service department for assistance with your faxination setting.
Another option for preventing claim denials is to utilize First Coast's SPOT (Secure Provider Online Tool) to respond to ADRs for claims on prepayment medical reviews. For instructions on how to respond to ADRs through SPOT, please review the SPOT: User Guide . If you don't already have a SPOT account, visit the SPOT page to learn about requesting one.
Examples with technical details for certain fax machines/systems
1. Faxination Server installation:
2. Ricoh multi-function device:
Note also that the switches and bits listed above may vary from machine to machine.
3. Biscom Fax Service:
• Set "FAX_DO_BATCHING" to "No" under the Advanced Parameter Configurations
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