Appeals
What you should do with claims returned as unprocessable
Claims that are returned as unprocessable cannot be appealed. So what do you do with them? An unprocessable claim is one that is filed with incomplete and/or invalid information. This article…
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.
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 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.
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.
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.
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.
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.
New Part A Medicare redetermination and clerical error reopening request form available now
Make sure to access our new and improved form which simplifies the submission of your Part A redeterminations.