Appeals
Appeal reminder for medically unlikely edits (MUEs)
We'd like to remind providers of medical documentation you'll need to submit when filing a redetermination or clerical error reopening for a claim (or line item) denied due to an MUE.
Before you appeal a claim or request a redetermination
Before you request a redetermination on a denied claim, review these tips to avert delays in payment and save some valuable time.
Appeal tips: Documentation to include with your Part A redetermination request
Learn what documentation to include when submitting a Medicare Part A appeals request.
Appeals status lookup tool: Part B help guide
This help document guides you through using the appeals status lookup tool on First Coast's Medicare provider website.
Claims and appeals for CPT 93010 performed in emergency room setting
Please review this article regarding appeals received for CPT 93010 (electrocardiogram report) and the use of modifier 77.
Positron emission tomography (PET) for oncologic conditions: Modifier usage
The appeals department is receiving appeals regarding the incorrect usage of modifiers associated with PET scans. Read this article to learn more about billing these services correctly.
Limitation of recoupment process (Medicare Modernization Act [MMA] 935)
Read this article to learn more about the 935 recoupment process.
Inpatient SNF services: Common denials and how to avoid them
First Coast wants you to prevent claim denials or unfavorable redetermination appeal decisions for inpatient SNF services.
Appealing new patient denials
Learn how to submit an appeal for evaluation and management services denials because the new patient did not meet new patient qualifications.
Appeal tips: Documentation to include with your Part B redetermination request
Learn what documentation to include when submitting a Medicare Part B appeals request.