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	Inpatient claims incorrectly receiving value code Q5	Inpatient claims with discharge date on and after October 1, are incorrectly receiving a value code Q5 by the Fiscal Intermediary Standard System (FISS). This displays on the remittance with CARC CO 237. The issue is currently being researched by FISS and CMS. We will provide updates as they are available.	Open	We will provide updates as they are available.	11/22/2021
Part A	Outpatient claims returned to provider with reason code 32200 and 31438	The issue has been resolved. Any claim RTP with reason code 32200 can be resubmitted. If the condition code A6 was added to the claim as a result of the RTP 32200 reason code and the claim RTP with reason code 31438, the A6 can be removed and the claim can be resubmitted.	Closed	Providers impacted by this issue should resubmit the claims for processing.	11/22/2021
Part A	Claims billed for monoclonal antibodies products are being returned to providers in error	First Coast identified an issue for claims billed with monoclonal antibodies HCPCS codes Q0240, M0240, M0241, M0244, M0246, Q0247, M0247, M0248, Q0249, M0249, and M0250. These services are being returned to providers (RTP) with reason code 32415 or 31498 in error. The issue has been resolved and claims should no longer RTP for this issue.	Closed	Providers impacted by this issue should resubmit the claims for processing.	10/20/2021
Part B	Reprocessing claims under the Primary Care First (PCF) model	A claim processing issue has been identified that potentially impacts all Cohort 1 Primary Care First (PCF) participants that submitted claims for flat visit fee (FVF) eligible services processed between January 1, 2021, and February 3, 2021. CMS and MACs are working closely to reprocess these claims to accurately reflect the PCF payment methodology. Claims reprocessing will begin in October 2021 and may continue through the end of the calendar year.	Open	No provider action is needed.	9/16/2021
Part B	Allowance of QW modifier on codes U0002 and 87635	Effective for dates of service on and after March 2, 2020, CMS added the QW modifier to procedure codes 87635 and U0002. However, the Common Working File (CWF) wasn’t updated to accommodate this request. An update has been made to the system.	Open	First Coast will reprocess claims for dates of service on and after March 2, 2020, that were denied when the QW modifier was reported on 87635 and U0002.	5/13/2021
Part A, Part B	Updated status indicator for Q5122	CMS updated the status indicator for HCPCS code Q5122 from “E2” to “K” for dates of service between January 1 and March 31. First Coast has updated the status indicator to “K”, the January 2021 OPPS payment quarterly rate, and the January 2021 OPPS 340B payment rate.	Open	First Coast will adjust claims when brought to our attention.	5/3/2021
Part B	Revised editing for ordering/referring providers on lab claims	CMS has revised editing to remove the ordering requirement from additional codes. This revised editing will be applicable to the following codes for dates of service on or after March 1, 2020: U0005, 86408, 86409, 86413, 87426, 87811, 0224U, 0226U, 87428, 87636, 87637, 0240U, 0241U, G2023, and G2024. The referring/ordering provider NPI will be required for procedure codes 87632 and 87633 effective for claims processed on or after May 4.	Open	If you think your claim denied in error due to missing ordering provider, includes one of the codes listed above, and is for a date of service on or after March 1, 2020, you can request a history correction reopening using the Claim Reopening Gateway.	5/3/2021