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: 8/2/2018
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: 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: 7/3/2018
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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