First Coast has identified an issue with claims billed with monoclonal antibodies (mAb) products are being returned to providers (status T) with reason codes 32415 or 31498 in error.
A claim processing issue was identified resulting in an error message when performing diagnostic related group (DRG) calculation for dates of service October 1 and after.
A claim processing issue has been identified that potentially impacts all Cohort 1 Primary Care First (PCF) participants that submitted claims for flat visit fee (FVF) eligible services processed between January 1, 2021, and February 3, 2021.
A claim processing issue has been identified resulting in cost sharing being applied to COVID-19 vaccine and mAb claims when submitted on TOB 12X, 13X, or 34X. This article was modified July 28 for provider action to address the reprocessing of claims.
During the public health emergency, CMS amended regulations to remove the requirement that certain diagnostic tests are covered only when ordered by the treating physician. Additional codes have been added that do not require an ordering provider on the claim.
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.
