Claim submission guidelines
Submitting claims when the dollar amount exceeds $99,999.99
First Coast has seen an increase in claims for drugs, hemophilia clotting factors, and skin substitutes that exceed the dollar amounts above $99,999.99. Effective for claims received on or after…
CMS-1500 (02/12) data element requirements
This document discusses the conditions and requirements of the Item fields within the revised CMS-1500 (02/12) paper claim form and the electronic equivalent elements.
Automated process for multiple PTAN matches to single NPI will reduce claim processing delays: Part A
For Part A providers with multiple facility PTANs linked to a single NPI, learn about our automated process to match the most appropriate PTAN to your NPI.
Important instructions for paper claim form CMS-1500 (version 02/12)
This article addresses important submission instructions for Optical Character Recognition (OCR) processing.
Outpatient Prospective Payment System (OPPS) addendums updates A, B, D1, and E
Review to find quarterly updates related to OPPS and I/OCE and review accessing the addendums* listed below.
Automated process for multiple PTAN matches to single NPI will reduce claim processing delays: Part B
For Part B providers with multiple billing PTANs linked to a single NPI, learn about our automated process to match the most appropriate PTAN to your NPI.
Process for supplying invoice amount on certain HCPCS codes - avoid rejected claims
The drug codes list and radiopharmaceutical codes lists have been updated.
Process for pathology, laboratory, and other codes
Avoid negative impacts to your claims by providing the medical records for the laboratory, pathology and other codes claims submissions indicated in this article. First Coast requests specific…
Hospital off-campus outpatient department reporting requirements
Effective July 6, 2026, outpatient claims with type of bills (TOB) 13X or 14X will be returned to provider (RTP) for reason code 34554 if modifier ER, PO, or PN is billed on all service lines, and…
Correct date of service for specific services
Physicians and non-physician practitioners need to identify the correct date of service for the services they provide to a Medicare patient. This article will discuss some of the situations where…