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Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
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This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
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Last Modified: 5/15/2020 Location: FL, PR, USVI Business: Part A

Claims overlap FAQs

Q: I have contacted the overlapping facility numerous times and have asked them to correct their claim, but the claim has not been corrected. What steps can be taken to get the other facility’s claim updated?
A: While providers and facilities are required and expected to work together to resolve the billing issue, providers may occasionally require assistance from the Medicare Administrator Contractor (MAC). In that case, First Coast Service Options (First Coast) will work with both the provider and the facility for resolution. In addition, when the overlapping claim is processed by another MAC, First Coast will work with that other MAC.
Complete and submit ‘Request for Assistance Form’
You may request assistance from First Coast to resolve your overlapping claims. Please complete, print and fax:
Supporting documentation must be included with your request
Fax to the First Coast Claims Department, at 904-361-0784
Note: Use a separate form for each request. This will enable First Coast to return each claim as it is completed, instead of holding claims until all claims on the request have been completed.
Upon receipt of the ‘Request for Assistance Form’, First Coast will take appropriate action within 30 calendar days. When First Coast is unable to complete the request within 30 days, we will provide a status and the reason for the delay on a copy of the request form. If you do not receive a status or response within 30 days of faxing the form, please submit a follow up request.
Source: CMS internet-only-manual (IOM), publication 100-04, Chapter 27 external pdf file, sections 50-50.3
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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.