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Last Modified: 5/10/2018 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
First Coast Service Options Inc. (First Coast) has identified that claims with dates of service January 1 through February 22, 2018, for Healthcare Common Procedure Coding System (HCPCS) code J0606 (Injection, etelcalcetide, 0.1mg) billed with a 72x TOB type were denied in error.
Open.
None. This error was corrected on February 22, 2018. First Coast will adjust affected claims.
4/20/2018
Part B
First Coast Service Options Inc. (First Coast) has identified Part B radiopharmaceutical claims processed March 27 through March 28, 2018, were denied in error. This error was corrected on March 29, 2018. Claims processed on or after March 29, 2018, were adjudicated correctly.
Open.
Providers whose claims were incorrectly denied due to this error do not need to take any action. First Coast will perform adjustments to correct the error on all the affected claims.
4/12/2018
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
Some claims/adjustments for ambulance services to and from dialysis facilities and/or physician services billed with modifier 26 were denied in error. This issue was resolved on February 27, 2018.
Open.
None at this time. First Coast is waiting on guidance from CMS.
3/16/2018
Part A
Part A therapy claims with dates of service on or after January 1, 2018, billed with HCPCS codes 97763 and G0515 were being denied in error. A correction was installed on March 1, 2018, and claims that were being held have been released from hold.
Closed.
None.
4/25/2018
Part A
Institutional claims were inappropriately rejecting with reason code 32404 when a revenue code between 030x-031x was submitted with a laboratory HCPCS that is not a clinical diagnostic lab code.
Closed.
As a workaround, FQHC and RHC providers were advised to remove claim line(s) that have been assigned reason code 32404 and resubmit the claim. Please discontinue this workaround beginning March 6, 2018.
3/6/2018
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
Part A
Deductible and coinsurance was being applied incorrectly for HCPCS G0473 (face-to-face behavioral counseling for obesity, 15 minutes) for TOB 13x for claims received on or after October 1, 2017. This was corrected with the January 2018 IOCE update release.
Closed
None. All mass adjustments have been completed.
2/15/2018
Part A, Part B
Contractors are required to implement 2017-2018 influenza vaccine payment allowances no later than October 2. Once files are updated, reprocessing will occur for claims processed on or after August 1. Medicare administrative contractors (MACs) will initiate a mass adjustment process to reprocess claims by November 1.
Closed
There is no action required by the provider.
2/2/18
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.