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Last Modified: 11/3/2020 Location: FL, PR, USVI Business: Part A, Part B
Current processing issues for Part A and Part B
The table below provides an at-a-glance look at processing issues being worked currently or resolved recently. To sort by line of business (LOB), status, or date last updated, click on that column's header. Click again to change between ascending or descending order.
Provider Action
Last Updated
Part A
Due to a FISS system error for claims processed July 2019 through April 2020, some claims did not process through local policy editing. First Coast has identified approximately 348,000 claims that will be adjusted because of this issue. The adjustments will begin on November 6 and can be identified on the remittance advice with a type of bill ending in “J”.
No provider action is needed. First Coast will automatically reprocess claims. Please respond to record requests that you receive for the previously paid claims.
Part B
Due to the COVID-19 public health emergency, CMS added CPT codes 99441-99443 to the list of Part B covered telehealth services under waiver. When furnished to a beneficiary in a SNF, these claims denied in error due to consolidated billing and will be reprocessed.
No provider action is needed. First Coast will automatically reprocess claims denied in error.
Part B
Effective for claims processed on or after July 17, 2020, for dates of service on or after January 27, 2020, First Coast will no longer deny claims when submitted with diagnosis codes Z03.818 and Z11.59, as long as all other coverage requirements are met for claims processing.
First Coast will adjust claims when brought to our attention.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.