Eligibility elimination from the IVR
The option to obtain patient eligibility information from the interactive voice response (IVR) system was eliminated on December...
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Update of the 2025 dollar amount in controversy required to sustain appeal rights for an Administrative Law Judge (ALJ) Hearing or Federal District Court Review
Section 1869(b)(1)(E) of the Social Security Act (the Act), as amended by Section 940 of the Medicare Prescription Drug...
First Coast HTTPS CAQH CORE compliant connectivity guide
This connectivity guide provides trading partners with instructions on how to successfully exchange electronic transactions with...
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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PC-ACE upgrade and installation instructions
PC-ACE version 6.9 is now available. Follow these instructions to complete the required quarterly upgrades or the full...
Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.
PWK option allows you to submit documentation with an initial claim
The PWK (paperwork) segment of the X12N version 5010 allows for submission of supporting documentation with a version 5010 837...
PC-ACE User Guide: Section 9 - Electronic reports
EDI Services generates multiple reports to assist you in easily tracking your electronic claims. These reports represent...
PC-ACE User Guide: Section 8 - Connect to First Coast
Once claims have been entered and prepared, the next step is to connect to First Coast. To do this, you will need a Network...