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Last Modified: 2/10/2025 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
An issue was identified regarding incorrect Medicare secondary payer (MSP) rejections related to billing and submission errors. Claims will be held until the fix is implemented. Once the fix is verified, we will adjust rejected claims finalized prior to the April 25th hold within 30 days. No action is currently required from the provider community.
Open

None.

5/2/2025
Part A, Part B
The annual fees for the 2024-2025 influenza season have been updated. Any codes paid using the payment allowances other than the fee published in the influenza vaccine pricing for the 2024/2025 season or that were denied and not allowed will be reprocessed. January 15, 2025 update: All impacted claims have been updated.
Closed

No action needed from providers on these claims

1/15/2025
Part A, Part B
CMS is aware of an issue were claims containing CPT code 90658, influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use, are pricing incorrectly. First Coast will hold claims for dates of service August 1 until October 7. Any denied claims will be reprocessed by November 1. January 15, 2025 update: All impacted claims have been updated.
Closed

Providers don't need to take any action on these claims

1/15/2025
Part B
CMS is aware of an issue that occurred on July 26, 2024, that affected some 2021 – 2024 professional claims for the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. If the reprocessed claim resulted in a complete recoupment of the ACO service, the demonstration message 92 will not display on the remittance advice. First Coast is working with CMS to correct this issue.
Open

Providers don't need to take any action on these claims for the reconciliations to occur

9/23/2024
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.