Appeals
Changes to Amount in Controversy (AIC) for Appeals in 2027
The claims value in dispute must meet the threshold for obtaining an administrative law judge (ALJ) hearing and a judicial review in federal district court. This is called the “amount in controversy…
Changes to Amount in Controversy (AIC) for Appeals in 2027
The claims value in dispute must meet the threshold for obtaining an administrative law judge (ALJ) hearing and a judicial review in federal district court. This is called the “amount in controversy…
Positron Emission Tomography (PET) for Oncologic Conditions: Modifier Usage
The appeals department received appeals regarding the incorrect usage of modifiers associated with PET scans. Read this article to learn more about billing these services correctly.
Tutorial: Completing the Medicare Part B Redetermination Request Form
To avoid processing delays, complete the Prior Authorization section of the Medicare Part B Redetermination Form only when the claim is associated with a Prior Authorization service. The “If this…
Submit Part A appeals and claim corrections electronically
Are you sending hardcopy mail to submit your requests to First Coast? Did you know there are faster and easier ways to send your requests to us? Avoid the wait. Learn about the electronic options…
Submit Part B financial documentation requests electronically
Are you sending hardcopy mail to submit your requests to First Coast? Did you know there are faster and easier ways to send your requests to us? Avoid the wait. Learn about the electronic options…
Submit Part B appeals and claim corrections electronically
Are you sending hardcopy mail to submit your requests to First Coast? Did you know there are faster and easier ways to send your requests to us? Avoid the wait. Learn about the electronic options…
Mandatory self-service clerical error reopening requests
Effective October 1 for all JN providers, Part B clerical error reopening (CERs) requests must be submitted using the SPOT Portal, the Reopening Gateway or the Interactive Voice Response (IVR) system…
Appeal tips: Documentation to include with your Part B redetermination request
Learn what documentation to include when submitting a Medicare Part B appeals request.