Payment issue affecting end stage renal dialysis services on type of bill 72X
Payment issue affecting end stage renal dialysis services on type of bill 72X.
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Ambulatory surgical center (ASC) prior authorization request (PAR) submission guidelines
View these submission guidelines for ASC prior authorization requests.
New provider roadmap: Appeals
An appeal is a new and independent review of an initial determination of a claim.
Step 1: Determine whether you are submitting a
...
Ambulatory surgical center (ASC) prior authorization (PA) claim submission guidelines
Prior authorization (PA) for the ASC prior authorization demonstration is voluntary. However, if a provider elects to bypass PA...
Prior authorization request (PAR) ambulatory surgical center (ASC) procedures Medicare Part B fax/mail coversheet
The PAR fax/mail coversheet for ASCs is now available for Florida ASCs participating in the ASC PA demonstration. ASCs in...
Changes to amount in controversy (AIC) for appeals in 2026
The claims value in dispute must meet the threshold for obtaining an administrative law judge (ALJ) hearing and a judicial...
Appeal status requests must be obtained through SPOT
To enhance efficiency and ensure the secure handling of appeal information, all providers will be required to use SPOT to check...
Medical documentation checklists
Use the links on the left to access checklists to ensure you have met medical documentation requirements based on specific...
Targeted probe and educate round results: Annual wellness visits (AWV)
Top denial / partial denial reasons and high-level results are listed below from each round of annual wellness visits (AWV)...
Medical review activities
Service-specific reviews
First Coast is tasked with preventing inappropriate Medicare payments. One of the ways this is conducted...