An issue has been identified where DDE claims submitted for processing with a Medicare beneficiary identifier (MBI) that are being returned for valid reasons cannot be corrected through the FISS DDE system.
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.
First Coast has identified Part A therapy claims billed with Healthcare Common Procedure Coding System (HCPCS) codes 97763 and G0515 are being denied in error.
Claims for 2018 for HCPCS code J0606 billed with type of bill (TOB) 72X were denied in error. The issue was resolved February 22; First Coast will adjust affected claims.
This table displays Part A and Part B processing issues that are being worked currently or have been resolved recently.
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.
The fiscal intermediary standard system (FISS) has identified an issue with some Medicare secondary payer (MSP) claims
Certain MSP claims are rejecting or suspending in error. This will be corrected on July 2, 2018. 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.
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.
Due to the October implementation of 2017-2018 influenza vaccine payment allowances, the Centers for Medicare & Medicaid Services has directed contractors to reprocess claims that were processed on or after August 1.
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