skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
Join eNews       En Español
Text Size:
YouTube LinkedIn Email Print
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 11/22/2021 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
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
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
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
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
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) wasnt 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
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
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
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.