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Last Modified: 8/10/2018 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.
LOB
Issue
Resolution
Status
Provider Action
Last Updated
Part A, Part B
The Centers for Medicare & Medicaid Services (CMS) has determined that codes J0881, J0883, J0885, J0888, and Q0138 were overlooked when the 2017 annual common working file (CWF) coding files were created. First Coast Service Options (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.
Open.
Providers should contact customer service to request claims reprocessing.
8/10/2018
Part A
CMS has determined that a system fix implemented on July 23, 2018, caused several transfer claims to process at full diagnosis-related group (DRG) pricing. This caused overpayments in claims that meet specific criteria. First Coast will adjust the impacted claims and overpayment demand letters will be issued
Open.
None. First Coast will complete the adjustments by October 1, 2018.
8/6/2018
Part B
Part B diagnostic colonoscopy claims billed with Modifier PT and screening diagnosis codes for dates of service May 17, 2018, through July 17, 2018, were denied in error. The issue has been resolved and claims denied in error will be adjusted.
Open.
None.
8/2/2018
Part A
The directives given in the reason code narrative to correct the XREF DCN cannot be completed by the provider at this time. A fix is scheduled to go into production on September 3, 2018.
Open.
Providers should contact customer service and provide the representative with the XREF DCN that needs to be canceled.
8/1/2018
Part A, Part B
HCPCS codes Q5105 and Q5106 were not added properly when the July 2018 consolidated billing coding files were created. First Coast will automatically override the appropriate SNF CB edits to allow these codes to process and pay when brought to its attention.
Open.
Providers should contact customer service to request that claims with dates of services on or after July 1, 2018, be reprocessed.
7/26/2018
Part A, Part B
Contractors shall suspend 85x bill types containing any of these edits. Edits W7020 and W7040: to adjust the reason code internal logic. Edits W7106, W7107, W7108: additional instructions regarding reprocessing CAH claims with these edits will be published when the October 2018 release is implemented.
Open.
Providers should adjust claims for edits W7020 and W7040 that rejected in error.
7/20/2018
Part A, Part B
CMS has determined that certain codes were overlooked when the 2017 and 2018 common working file (CWF) coding files were created. First Coast will override the appropriate SNF consolidated billing (CB) edits to allow these codes to process and pay when brought to its attention.
Open.
Providers should contact customer service to request claims with dates of service on or after January 1, 2017, processed until July 2, 2018, to be reprocessed.
6/29/2018
Part A, Part B
A system edit has been turned off that was rejecting and denying claims for certain electrocardiographic (EKG) services. Medicare administrative contractors (MACs) will reprocess impacted claims.
Open.
None.
6/29/2018
Part A
Certain MSP claims are rejecting or suspending in error. 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. This article was revised to provide three scenarios for possible provider action.
Open.
Click here for possible provider action.
8/3/2018
Part A, Part B
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.
Open.
Providers should contact customer service to request claims for these CPT® codes (77770, 77771, and 77772) be reprocessed to override the SNF CB edit.
4/12/2018
Part B
It has come to the attention of First Coast Service Options Inc. (First Coast) that the activities used to initiate replacement qualified Medicare beneficiary (QMB) remits has resulted in overpayments on some adjustments. At this time a resolution has not been identified; First Coast staff is meeting internally to discuss how best to address the issue. Updates will be provided as they become available
Open
None. Note that the provider call center is unable to provide a resolution at this time.
5/10/2018
Part A, Part B
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.
Open
None. Please refer to this article external website PDF file on the CMS website for a guide to identify cost-sharing amounts. Note that the provider call center is unable to provide a resolution at this time.
5/10/2018
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.