Submit Part A appeals and claim corrections electronically

Are you using regular mail for submissions to First Coast? We have several electronic options that are easier and faster for you to use. Additionally, submitting documentation electronically: 

• Saves time, electronic submission eliminates mailing delays
• Eliminates administrative costs, electronic submission costs nothing
• Protects patient information, electronic submission is secure
• Allows for the immediate confirmation of receipt, electronic submission provides transaction confirmations

Read on to find out how you can avoid the wait by submitting electronically.

What are you trying to submit to First Coast?

• Appeal:
  • First level - redetermination
  • Second level - reconsideration
• Clerical reopening request
• Claim correction

First level appeal (redetermination)

An appeal is a new and independent examination of a claim due to dissatisfaction with the initial claim determination. 

A redetermination request is the first level of the appeal process and is sent to the MAC who processed the claim. A provider has 120 days from the receipt of the claim determination notice to file a redetermination request:

• Submit using the Medicare Part A Redetermination and Clerical Error Reopening Request form. 

Electronic submission of an appeal request to First Coast can be performed using the following methods:

Second level appeal (reconsideration)

A reconsideration request is the second level of the appeal process and should be sent to the Qualified Independent Contractor (QIC), not the MAC. A provider has 180 days from the receipt of the redetermination notice to file a reconsideration request:

• Submit using the Medicare Reconsideration Request form.

Electronic submission of an appeal request to the QIC can be performed using the following methods:

Claim reopening request

A claim reopening request can be submitted to the MAC for claim submission error(s) or inaccurate data entry to request an adjustment to the initial claim submission. 

A claim reopening request must be submitted to the MAC within one year from the initial claim determination:

• Submit using the Medicare Part A Redetermination and Clerical Error Reopening Request form.

Electronic submission of claim reopening requests to First Coast can be performed using the following methods:

Claim correction

Claim submission errors may necessitate the need for a correction, an adjustment or a cancel and rebill of the initial claim submission. 

• Claim adjustment can be made directly by the provider to a processed or rejected claim:
  • Access claims corrections from the Fiscal Intermediary Standard System (FISS) Main Menu
  • Select your type of service / facility in the Claim Adjustments Menu
  • Claim correction is submitted as an XX7 type of bill (TOB)
• Claim correction can be made directly by the provider to a return to provider (RTP) claim:
  • Access claims corrections from the FISS Main Menu
  • Select your type of service / facility in the Claims Corrections Menu
  • Update claim and F9 to store new data
• Claim cancel can be made directly by the provider for a denied claim or to correct a denied line item that was billed with error(s) or inaccurate data entry:
  • Access claims corrections from the FISS Main Menu
  • Select your type of service / facility in the Claim Adjustments Menu
  • Claim cancel is submitted as and XX8 TOB
  • Allow claim to finalize and cancel before rebilling new claim
• A claim correction must be done in accordance with Medicare guidelines for timely filing:
  • One year from the date of service for outpatient claims
  • One year from the date of discharge for inpatient claims

A claim correction can be performed using the following methods:

First Coast offers free education on the submission methods described above. Access the following to learn more:

• Live Events calendar
• On-Demand Learning education

Back to the Avoid the wait home page to explore more topics and options for electronic submission:

• Part A Avoid the wait