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
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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...
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.
Claim Reopening Gateway - Help Guide
Welcome to the First Coast Claim Reopening Gateway Help Guide. The Claim Reopening Gateway is an interactive tool that requires...
Advance payment – Part B only
View this article for information about Part B advance payment submissions.
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...
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...
Tutorial: Completing the Medicare Part A redetermination and clerical error reopening request form
Review our tutorial and learn how to correctly complete this form to ensure more accurate processing.