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Last Modified: 10/4/2022 Location: FL, PR, USVI Business: Part B

LOB

Part B

Issue

National system issue inadvertently adjusted certain Part B claims

Resolution

CMS identified a national system issue which may have inadvertently adjusted previously processed Part B claims with dates of service (DOS) on or after January 1, 2021. These adjustments processed on July 29 through August 2, 2022.
Impacted codes included the following: 99202-99205, 99211-99215, 99324-99328, 99334-99337, 99341-99345, 99347-99350, 99354-99355, 99495-99498, G0402, G0438, G0439, 99415, 99416.

Status/date resolved

Open

Provider action

Most of the claims that inadvertently adjusted did not result in a change in payment; therefore, most providers were not impacted and no actions are required. If the adjustment caused a payment change or denial and you disagree with the decision, please submit an appeal.   
Claims for providers participating in the Primary Care First model are being reprocessed in some instances due to an error with a CMS Change Request for the Fee-For-Service claims processing system, which resulted in an incorrect payment. The reprocessing will ensure the provider receives the correct payment of a Flat Visit Fee rather than the Fee-For-Service fee for appropriate claims.

Current processing issues

Here is a link to a table of current processing issues for Part B.
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.