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Last Modified: 6/12/2017 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
Some providers may notice a difference in how deductible and coinsurance amounts are being displayed on the remittance advice for QMB claims. CMS will revert back to the previous display on December 8, and until then, CMS has provided a guide to identify Medicare cost-sharing amounts on remittance advice.
Open
None. Please refer to this article external website PDF file on the CMS website for a guide to identify cost-sharing amounts.
11/16/2017
Part A
Currently, deductible and coinsurance is 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 will be corrected with the January 2018 IOCE update release.
Open
None. The system will be updated in January 2018; Medicare administrative contractors will mass adjust these claims within 60 calendar days of the update.
10/27/2017
Part A, Part B
Due to a file upload for a range of ICD-10 diagnosis codes, claims were denied in error (although the claim was billed correctly). The system upload impacted claims processed on September 28, 2017, and September 29, 2017, with a receipt date of September 27, 2017, and September 28, 2017. First Coast will identify and reprocess any incorrect denials.
Open
There is no action required by the provider.
10/12/2017
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.
Open
There is no action required by the provider.
10/3/2017
Part A
Providers are reporting occurrence span code (OSC) 70 with a date range 30 days or more before the skilled nursing facility (SNF) admission date (receiving reason code 11503) on claims with condition code DR or modifier CR. Providers should not report OSC 70 on claims billed with CC DR or modifier CR.
Open
Remove the OSC 70 when reporting CC DR or modifier CR.
9/14/2017
Part A
Claims are rejecting in error with CWF reason codes U6816, U6817, and U6818 when Part A claims are billed with the applicable CARC codes listed in CR 8984 and CR 9009 which permits a residual payment if the services billed are covered and payable by Medicare.
Open
None.
8/28/2017
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.