Processing Issues
Modified: 11/8/2018
This table displays Part A and Part B processing issues that are being worked currently or have been resolved recently.
Modified: 11/8/2018
Therapy claims adjusted due to the QMB remit issue are now denying for timeliness. These claims will be reprocessed by First Coast.
Modified: 11/6/2018
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 completed adjusting the impacted claims by October 1, 2018.
Modified: 11/2/2018
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: 9/19/2018
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: 9/10/2018
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.
Modified: 9/10/2018
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.
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