This table displays Part A and Part B processing issues that are being worked currently or have been resolved recently.
Therapy claims adjusted due to the QMB remit issue are now denying for timeliness. These claims will be reprocessed by First Coast.
An IPPS fix implemented by CMS on July 23, 2018, caused several claims to pay at full DRG payment rate, which caused overpayments. First Coast completed adjusting the impacted claims by October 1, 2018.
Certain codes were overlooked when the 2017 CWF coding files were created. When brought to its attention, First Coast will override the appropriate SNF CB edits to allow for processing and payment of these codes, and will do so until the codes are correctly added to the 2017 files in January 2019. Providers should contact customer service to request claims reprocessing.
First Coast Service Options discovered that claims involving more than four concurrent anesthesia procedures have resulted in overpayments for claims paid from January 1, 2013, through July 20, 2018. First Coast started adjusting the claims August 30, 2018, to recover the overpayments.
There are no items in this section at this time.
Part B claims for diagnostic colonoscopy billed with modifier PT and screening diagnosis codes denied in error
An issue has been identified for Part B diagnostic colonoscopy claims billed with Modifier PT and screening diagnosis that have been denied in error.
Certain codes were overlooked when the 2017 and 2018 CWF coding files were created. When brought to its attention, First Coast will override the appropriate SNF CB edits to allow for processing and payment of these codes, and will do so until the codes are correctly added to the 2017 and 2018 files in October 2018. Providers should contact customer service to request claims reprocessing.
Change request (CR) 10494 provides for adjustments to QMB claims processed under CR 9911; however, errors to those adjustments occurred. This article details corrections to those errors.
Reason codes 30900 or 30905 are setting when an adjustment is processed and the original claim is purged or not found on history causing claims to RTP with reason code EA002. A fix is scheduled for October 1, 2018.
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.