What you should do with claims returned as unprocessable
First Coast is experiencing a large volume of appeals filed on claims that were returned as unprocessable. Claims that are considered returned as unprocessable are not appealable.
Do not file an appeal
- When you file an appeal on an unprocessable claim, First Coast will return the correspondence to you with a letter instructing the provider to refile a new claim. Response letters are typically generated within 60 calendar days after your appeal request was submitted.
- Filing an appeal on an unprocessable claim only delays payment and could result in a timely-filing denial if not re-filed with the correct information within the timely-filing period.
How to handle a claim returned as unprocessable
- Claims returned as unprocessable will include the MA130 remittance advice message with a corresponding reason code message to denote why the claim was incomplete or invalid.
- Review these frequently-asked questions to determine why First Coast was not able to process the claim.
- Resubmit a corrected claim.
The Medicare guidelines for unprocessable claims can be found in the Medicare Claims Processing Manual (100-04), Chapter 1, Section 80.3.
The Medicare guidelines for completion of form CMS-1500 can be found in the Medicare Claims Processing Manual (100-04), Chapter 26, Section 10.