Part A

End-stage renal disease (ESRD) claims for the U.S. Virgin Islands processed with negative reimbursement in error. A system fix was implemented on January 6, 2020, to correct the issue.

Open.

Providers should take the necessary steps to adjust their impacted claims.

1/24/2019

Part A, Part B

Claims containing new diagnosis codes I48.11, I48.19 and I48.21, processed prior to January 16, 2020, may have denied in error. As of January 16, 2020, when claims are brought to our attention with dates of service on or after October 1, 2019, First Coast Service Options (First Coast) will override the medical policy edit to allow services under these NCDs to process and pay when one of the diagnosis codes above are present on the claim.

Open.

Providers should request that affected claims with dates of service on or after October 1, 2019, processed until January 16, 2020, be reprocessed.

1/23/2019

Part A, Part B

Change request (CR) 10955 (implemented April 1, 2019) revised existing CWF SNF CB edit 7275 and the associated informational unsolicited response (IUR). Edit 7275 is denying Part B ambulance claims inappropriately. Medicare administrative contractors (MACs) will manually bypass the CWF SNF CB 7275 for incoming ambulance transportation claims containing HCPCS code A0427, A0429, or A0433 billed with or without A0425.

Open.

None; however, MACs will reprocess claims brought to their attention that were denied in error.

11/4/2019