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Last Modified: 5/17/2016 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 B
Claims submitted for computed tomographic angiography of the chest, heart, and coronary arteries between October 1, 2015, and September 5, 2016, may have been denied in error when billed with certain diagnosis codes. This error was corrected September 6, 2016. First Coast Service Options Inc. will perform adjustments to correct the errors on affected claims.
Closed.
None.
12/30/2016
Part A
First Coast has become aware of processing issues for pneumococcal and influenza vaccinations where in some instances the vaccination is not being priced, and in other instances, the vaccination is being priced; however, coinsurance is being applied in error. This problem is currently under review for resolution; an update will be provided as soon as an outcome has been determined.
Open.
None.
12/20/2016
Part B
Healthcare Common Procedural Coding System (HCPCS) code J7328 was overpaid in error for dates of service on or after January 1, 2016. The Medicare administrative contractor updated the payment rate for claims processed on and after December 6, 2016.
Closed.
Providers should submit voluntary refunds of overpaid amounts. Providers do not need to contact customer service.
12/15/2016
Part A
Claims submitted related to local coverage determination (LCD) L33618 - major joint replacement (hip and knee) between October 1, 2015, and January 28, 2016, may have been returned to the provider (RTP) in error when billed with ICD-10-CM procedure codes 0SP90JZ, 0SPB0JZ 0SPC0JZ, and 0SPD0JZ. Claims processed on or after January 28, 2016 were adjudicated correctly.
Closed.
Providers will need to resubmit their claims and indicate “ICD-10 Major Joint Replacement” on the claims. Providers do not need to contact customer service.
12/7/2016
Part A
Change request (CR) 9806 announced significant changes to 23 national coverage determinations (NCDs) involving ICD-10 diagnosis editing. These changes will be implemented December 5, 2016, for dates of service on and after October 1, 2016. Claims that denied with reason codes in the 5xNCD series with diagnosis codes updated with CR 9806 will be adjusted when brought to our attention after December 5, 2016.
Open.
Denied Part A claims will be adjusted when brought to our attention after December 5, 2016.
11/28/2016
Part B
Change request (CR) 9806 announced significant changes to 23 national coverage determinations (NCDs) involving ICD-10 diagnosis editing. These changes will be implemented December 5, 2016, for dates of service on and after October 1, 2016. Services impacted by these changes submitted prior to the December 5 will be denied.
Open.
None. Claims submitted prior to December 5 for dates of service on and after October 1, 2016, that denied in error will be automatically adjusted.
11/28/2016
Part B
First Coast Service Options Inc. has identified an internal processing issue that resulted in overpayments related to the application of skin substitute grafts for treatment of diabetic foot ulcers (DFU) and venous leg ulcers (VLU) of lower extremities.
Open.
Providers who received payment in error will receive a demand letter requesting the monies back.
11/18/2016
Part B
First Coast Service Options Inc. has identified an internal processing issue that resulted in overpayments related to specimen validity testing (SVT). Providers who received payment in error will receive a demand letter requesting the monies back.
Open.
Providers who received payment in error will receive a demand letter requesting the monies back.
11/18/2016
Part A
Some inpatient prospective payment system (IPPS) hospital and long-term care hospital (LTCH) claims with discharge dates on or after October 1, 2016, may be grouped to an incorrect Medicare severity -- diagnosis related group (MS-DRG). First Coast Service Options Inc. will perform adjustments to correct the errors on all the affected claims.
Open.
No provider action is required.
11/17/2016
Part B
Claims submitted for procedure code 92025 between October 1, 2015 and August 7, 2016, may have been denied in error when billed with diagnosis codes H11.811-H11-819, H18.51, H18.52, H18.53, H18.54, and H18.55. Claims processed on or after August 8, 2016, were adjudicated correctly. First Coast Service Options Inc. will perform adjustments to correct the errors on all the affected claims.
Closed.
No provider action is required.
11/14/2016
Part A
Reason code W7099 was suspending non-OPPS claims in error. A workaround provided by the Center for Medicare & Medicaid Services (CMS) was implemented by First Coast Service Options Inc. October 24; all claims have been reprocessed. OPPS claims were not impacted.
Closed.
No provider action is required.
11/1/2016
Part B
A national issue has been discovered whereas claims and/or adjustments are denying incorrectly via ICD-10 system logic. A system fix was implemented on September 15, 2016, to correct this issue. The impacted claims are currently being identified. Your Medicare administrative contractor (MAC) will adjust any claim processed incorrectly.
Open.
No provider action is required.
9/26/2016
Part B
Ambulatory surgical centers (ASCs) that received an incorrect payment for Healthcare Common Procedure Coding System (HCPCS) C1822 and/or Current Procedural Terminology (CPT®) 63685 when performed with HCPCS C1822 received adjustments to previously processed claims.
Closed.
None.
12/20/2016
Part A
Procedure codes 0V507ZZ and 0V508ZZ were listed in the FISS narrative in reason codes (RCs) 34912, 59055, and 59056 in error. This issue has been corrected and the reason codes have been reactivated per change request 9631.
Closed.
None.
12/5/2016
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.