Changes to Amount in Controversy for Appeals in 2027
The claims value in dispute must meet the threshold for obtaining an administrative law judge (ALJ) hearing and a judicial...
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Tutorial: Completing the Medicare Part B Redetermination Request Form
To avoid processing delays, complete the Prior Authorization section of the Medicare Part B Redetermination Form only when the...
Positron Emission Tomography (PET) for Oncologic Conditions: Modifier Usage
The appeals department received appeals regarding the incorrect usage of modifiers associated with PET scans. Read this article...
Good cause for extension of the time limit for filing appeals
The time limit for filing a request for redetermination may be extended in certain situations. Good cause may be found when the...
Submit Part B appeals and claim corrections electronically
Are you sending hardcopy mail to submit your requests to First Coast? Did you know there are faster and easier ways to send your...
Submit Part B financial documentation requests electronically
Are you sending hardcopy mail to submit your requests to First Coast? Did you know there are faster and easier ways to send your...
Submit Part A appeals and claim corrections electronically
Are you sending hardcopy mail to submit your requests to First Coast? Did you know there are faster and easier ways to send your...
Mandatory self-service clerical error reopening requests
Effective October 1 for all JN providers, Part B clerical error reopening (CERs) requests must be submitted using the SPOT...
Limitation of recoupment process (Medicare Modernization Act [MMA] 935)
Read this article to learn more about the 935 recoupment process.