Last Modified: 11/24/2022
Location: FL, PR, USVI
Business: Part A
Q1. Is it necessary to complete the Medicare credit balance report certification if we do not have any credit balances to report?
A1. You must sign and return the certification form even if your total credit balance amount for Part A and Part B is zero. You may fax credit balance reports to 904-361-0359, Attention: Credit balance.
Q2. I adjusted my outstanding credit balance, but the adjustment has not processed by the end of the quarter. Do I include this on my credit balance report?
A2. Yes, you must report any credit balances that are still outstanding by the quarter ending. Report an "X" in column 11 of the 838-detail page.
Q3. When is the report due?
A3. The report must be filed within 30 days after the end of the quarter (no later than January 30, April 30, July 30, and October 30).
Q4. What are the consequences for late filing?
Failure to file a quarterly report by the due date, to comply with the stipulated reporting requirements, can result in the suspension of all Medicare payments and face possible interest assessment. The CMS IOM, Pub. 100-06, Medicare Financial Management Manual, Chapter 12
outlines the procedure for assessing interest on outstanding balances. This bulletin is a PDF and requires Adobe Acrobat Reader, which is free to download
Q5. Are there instructions for completing the credit balance report?
For detailed help on what constitutes a credit balance, how to complete the individual fields and pay amounts owed to Medicare, refer to CMS’ Medicare Provider Instructions
Q6. Can we file the credit balance report electronically?
You cannot email or submit your report online, but we encourage you to use the online approved version of the CMS-838 Credit Balance Report
for quarterly reporting purposes. You will fill out the report online and either fax the report to 904-361-0359 or submit the report through SPOT's secure documentation feature. This is the only version of the report that we accept.
Q7. If we choose to repay the credit balance by check, to whom should it be made payable and where should it be mailed?
A7. You must use this address when repaying your credit balance by check. Please be sure to include your Medicare credit balance report certification page, your completed 838, and any additional documentation along with your check.
First Coast Service Options
P.O. Box 3162
Mechanicsburg, PA 17055-1837
Q8. Where do we send reports using other payment types?
A8. You can fax reports using other payment types to 904-361-0359 or submit through SPOT's secure documentation feature.
Q9. Why would my report be rejected?
A9. There are numerous reasons why reports are rejected. One reason for rejections is when an 838-certification page is incomplete or invalid. Please make sure you're using the following when completing your certification:
• The correct version of the CMS-838 Certification Page/Detail Page. Please use the correct version of the CMS-838 Credit Balance Report. You can type directly into this version which is strongly encouraged to ensure your report is legible. Once completed in full, the report should be printed for signatures.
• 6-digit provider number (do not use NPI or the dash)
• The appropriate quarter ending date (must be in mm/dd/ccyy format and must be either 03/31/20xx, 06/30/20xx, 09/30/20xx, or 12/31/20xx)
• Signature is required
• Block must be checked (check only one block)
• If no credits to report, check either the first or third block. Check the second block only when credits are reported.
• If your certification page meets all the requirements, your report can still reject if you reported credits.
• The detail page(s) must be completed in full.
• All header information must be completed, including the provider number, quarter ending, Part A or B, and contact information for the person we can reach if questions arise.
• Blocks 1-15 should be completed in full, including the beneficiary name, Medicare Beneficiary Identifier (MBI) number, and ICN.
Here are some of the reasons why reports containing detail pages are rejected:
• Invalid type of bill (block 4)
• Missing admin / discharge / pay dates (blocks 5-7)
• Amount of credit balance (block 9)
• Method of payment (block 11)
• "X" is used if you've initiated the adjustment, but it didn't finalize before the end of the quarter.
• "A" is used if the adjustment wasn't initiated and a corrected UB-04 is required to be submitted with your report.
• "C" is used if you're submitting a check with your submission. Reports with checks must be mailed to the physical address and the check must accompany your report. Copies of the report must not be faxed!
Reason for credit balance (block 13) (numeric only).
• "1" indicates a duplicate.
• "2" indicates MSP, therefore, in addition to indicating a 2 in block 13, blocks 14 and 15 must be completed.
• "3" indicates 'other' (nothing goes in block 14; block 15 can be completed with comments, but comments are not necessary).
• Value code (block 14). Complete ONLY when MSP is reported in block 13.
• Primary payer (block 15). Complete ONLY when MSP is reported. However, comments can be added when explaining "3" as the reason for credit balance.
Q10. How are we notified if our report was rejected?
A10. All reports should be received by fax. Your coversheet or fax pages should contain the number from which the fax originated so we can fax back the rejection cover sheet along with your submission. The cover sheet will detail the reason for rejection. When we receive the report by mail (and again, they must be faxed), rejections are mailed. Telephone calls may be made if there is no fax number or mailing address indicated.
Q11. Even though my report was rejected, I mailed it timely. Why did I get a letter stating my report wasn't received timely?
A11. Rejected reports, those deemed invalid, are not considered received until they are submitted without errors. Therefore, if they haven't been entered into our database as valid, letters are mailed 15 days after the due date.
Q12. Where do I send my corrected report?
A12. You may fax your corrected report, in its entirety, to 904-361-0359 (do not mail) or through SPOT's secure documentation feature.
Q13. Where can I find valuable information on credit balance reporting?
Everything you need to file your credit balance report can be found on the credit balance reporting page of our website. This page includes links to quarterly updates, the official version of the CMS-838 Credit Balance Report and instructions on how to complete the report, and an excel version of the detail page. Additionally, you will find submission dates, due dates, fax number and mailing address for check submissions, as well as link to our FAQ document. You may also email JNcreditbalanceinquiries@fcso.com
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.