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Last Modified: 12/6/2017 Location: FL, PR, USVI Business: Part A, Part B

Payment floor FAQs

Q: How long is the payment floor waiting period?
A: There are different waiting periods for electronic claims and paper claims. The waiting periods are 13 days for electronic claims and 28 days for paper claims. However, the payment may not be issued until day 14 (electronic) or 29 (paper).
Source: CMS IOM, Pub 100-04, Chapter 1, Section 80.2.1.2
Q: What is the definition of "payment floor?"
A: The “payment floor” is a waiting period during which time the contractor may not pay, issue, mail, or otherwise finalize the initial determination on a clean claim.
Source: CMS IOM, Pub 100-04, Chapter 1, Section 80.2.1.2
Q: What is the definition of a "clean" claim?
A: A “clean” claim is one that does not require the carrier or fiscal intermediary to investigate or develop external to their Medicare operation on a prepayment basis. Clean claims must be filed in the timely filing period.
Source: CMS IOM, Pub 100-04, Chapter 1, Section 80.2
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.