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Last Modified: 1/24/2020 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
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.
Providers should take the necessary steps to adjust their impacted claims.
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.
Providers should request that affected claims with dates of service on or after October 1, 2019, processed until January 16, 2020, be reprocessed.
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.
None; however, MACs will reprocess claims brought to their attention that were denied in error.
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.