Processing Issues
Modified: 8/10/2018
This table displays Part A and Part B processing issues that are being worked currently or have been resolved recently.
Modified: 8/10/2018
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.
Modified: 8/8/2018
The July 2018 integrated outpatient code editor (I/OCE) implemented program logic to include edits W7020, W7040, W7106, W7107 and W7108 for outpatient (85x) critical access hospital (CAH) claims. Contractors will temporarily suspend outpatient CAH claims containing any of these edits. Providers should adjust CAH outpatient claims for edits W7020 and W7040 that rejected in error.
Modified: 8/6/2018
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 will adjust the impacted claims by October 1, 2018.
Modified: 8/3/2018
Certain MSP claims were rejecting or suspending in error. Claims rejected in error will be adjusted and claims suspended in error will be released. First Coast will override timeliness when applicable to process these claims. This article was revised August 3 to provide three scenarios for possible provider action.
Modified: 8/2/2018
An issue has been identified for Part B diagnostic colonoscopy claims billed with Modifier PT and screening diagnosis that have been denied in error.
Modified: 8/1/2018
An issue has been identified with the direct data entry (DDE) system when providers are submitting cancel claims. The claims are being returned to the provider (RTP) with reason code 30955 and cannot be corrected through the DDE system.
Modified: 7/26/2018
HCPCS codes Q5105 and Q5106 were not added properly when the July 2018 SNF consolidated billing files were created. When brought to its attention, First Coast will override the SNF CB edits to allow for processing and payment of these codes until the codes are correctly added to the files in October 2018. Providers should contact customer service to request claims reprocessing.
Modified: 7/20/2018
There are no items in this section at this time.
Modified: 7/3/2018
Some providers may notice a difference in how deductible and coinsurance amounts are being displayed on the remittance advice for QMB claims. CMS reverted back to the previous display on December 8, and provided a guide to identify Medicare cost-sharing amounts on remittance advice. A permanent solution is tentatively scheduled for summer 2018. No provider action is required.
Modified: 6/29/2018
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.
Modified: 6/20/2018
This article announces a system edit for certain electrocardiographic (EKG) services has been turned off and Medicare administrative contractors will adjust impacted claims. No action is required by the provider.
Modified: 5/18/2018
Certain radiation therapy codes were overlooked when the 2016, 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, and will do so until the codes are correctly added to the 2016, 2017, and 2018 files in October 2018. Providers should contact customer service to request claims reprocessing.
Modified: 5/10/2018
It has been brought to our attention that the activities used to initiate replacement QMB remits has resulted in overpayments on some adjustments. No provider action is required at this time.
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