Part B interactive voice response (IVR) operating guide

1-877-847-4992

First Coast strives to provide you with the most up to date automation features as possible. The IVR operating guide will help to increase your knowledge of the technology and services we offer our providers. You may also find our IVR Quick Reference Guide helpful.

Hours of operation

IVR unit hours of availability

The IVR is available 24 hours a day, 7 days a week, except for regularly scheduled maintenance.

Note: Specific claim and/or eligibility information is only available during the following times, with the exception of holidays: 

• Monday - Friday 7 a.m. to 6:30 p.m., ET 

• Saturday 6 a.m. to 3 p.m., ET

Touchtone or speech

All callers have the option of selecting speech or touchtone when using the IVR. In order to receive maximum, results you deserve when speaking we offer the following tips:

• Use a telephone with a handset or headset
• Avoid using a speakerphone or cell phone
• Avoid calling from areas with loud background noise
• Speak the requested information clearly in a quiet environment

*When using the speech recognition option on the IVR, and keying the date is required (date of service, date of birth, etc.), the date must be given in 8-digit format (mm/dd/yyyy). 

In the event the system does not accept the spoken information, touch-tone is always available. In order to receive the maximum results you deserve when using touch-tone we offer the following tips:

• Dates should be entered in the following format (mm/dd/yy)
• To signal you are entering an alpha suffix or letter, press the * key
• Press the key that includes the letter, then the corresponding number that denotes where the letter is located on the number key.
• If the patient’s last name contains a suffix, hyphen, or apostrophe, enter up to six letters before the special character. Stop entering once you reach the special character up to a maximum of six letters, whichever comes first. (Example: if the last name is “De-Amaro” enter only “DE”).
• If the patient’s last name contains a space between two last names, callers should enter the first six letters of the ‘primary’ last name for beneficiary authentication. (Example: if the last name is “Correa Augusto” enter “CORREA” for the last name).
• After all letters desired have been keyed, press the pound (#) sign to end your entry. 

Use the numbers on the telephone keypad that corresponds to the patient or provider number:

A = *21#

Q =*72#

R = *73#

Z = *94#

Helpful tips

As a result of the Health Insurance Portability and Accountability Act (HIPAA), we are required to protect the privacy of all individuals. You must have the following information available for authentication to access patient eligibility, deductible and claims information from the IVR:

• National Provider Identifier (NPI)
• Provider Transaction Access Number (PTAN)
• Tax Identification Number (TIN)
• Beneficiary Medicare ID
• Beneficiary name
• Beneficiary date of birth
• Date of service (if applicable)

Main menu - number / options

1. General information
2. Claim status, correspondence/appeal status and claim reopenings
3. Eligibility
4. Pending claims and month or year-to-date dollar amounts
   
5. Check status
6. Remittance codes, pricing of procedure codes and prior authorization inquiries
7. Enrollment information

General information: Press 1

• Training and holiday closures, press 1
• Hot topics, press 2
• Provider outreach and education information, press 3
• General MSP and appeals information, press 4
• Hours of operation, press 5

Claim status correspondence/appeal status and claim reopenings: Press 2

For claim status, press 1: 

Assigned claim status

• Pending, finalized, denied
• Date of service
• Amount submitted
• Processed date
• Deductible
• Payment amount
• Payment date
• Check number
• Internal Control Number (ICN)
• Supplemental insurance (Forwarded or not)

Non - assigned claims

• Processed date
• Amount submitted
• Payment date
• Supplemental insurance (forwarded or not)

Additional claim detail

*This menu is offered after the information above has been voiced.

• Procedure code
• Date of service
• Billed amount and allowed amount for each procedure code
• Denial message

For correspondence and appeal status, press 2

• IVR will voice date correspondence or appeal was completed and the Correspondence Control Number (CCN)

To request a telephone reopening of a claim, press 3

• The IVR will prompt for individual detail line adjustments, press 1. To request to have an entire claim reprocessed without making any changes, press 2. If option 1 is pressed, the following individual detail line adjustment types are offered:
• Changes to date of service, press 1
• To add, delete, or change a modifier, press 2
• To change a diagnosis, press 3
  Note: This option is only for the primary diagnosis for a procedure.
• To change a procedure code and billed amount (if desired), press 4
• To change the quantity billed and billed amount (if desired), press 5
• To update the Ordering or Referring provider information, press 6

Eligibility information: Press 3**

• For current eligibility information, press 1

  • Entitlement date
  • Termination date (if applicable)
  • *Part B deductible
  • Current Year deductible
  • Previous Year deductible
  • Deductible information not provided for patients enrolled as a Qualified Medicare Beneficiary (QMB)
  • Medicare Advantage information
  • Medicare is primary or secondary

  If Medicare Advantage Plan is found, you can press 1 for more information.

  • The IVR will give the Medicare Advantage Plan number
  • Plan type
  • Plan name, address, and telephone number
  • Effective dates and termination date of policy

  If Medicare is secondary, press 1 for additional MSP details

  • Type of primary insurance
  • Effective and termination date for all valid insurers for either current or previous date of service.
  • For eligibility for a previous date of service, press 2
  • For physical and occupational therapy Information, press 3
  • For Medicare Advantage Plan information, Press 4
  • Caller enters a specific Medicare Advantage plan number to receive specific information such as:
    • Plan Type
    • Plan name, address, and telephone number
      Note: After primary eligibility information is obtained, the IVR will prompt the caller to press an option for additional eligibility.

**Note: Certain provider specialty types may only receive limited eligibility information.

Sub menu for additional eligibility menu

• Skilled nursing facility (press 3)
  • SNF effective date
  • Termination date (if applicable)
  • Servicing provider name, address, and telephone number
• Hospice (press 4)
  • Hospice effective date
  • Termination date (if applicable)
  • Servicing provider name, address, and telephone number
• Home health (press 5)
  • Home health effective date
  • Termination date (if applicable)
  • Servicing provider name, address, and telephone number

Pending claims information and month-to-date or year-to-date dollar amount on file: Press 4

• For current number of pending claims and their combined billed amount, press 1
• For month or year-to-date number of claims processed and paid amounts, press 2
• For the previous year paid amount, press 3

Check information: Press 5 

• For the last three checks, press 1
  • Issue Date
  • Check Number
  • Check Amount (if applicable)
  • Check Status (outstanding/cleared)
• For check history by issue date, press 2
  • Issue Date
  • Check Number
  • Check Amount (if applicable)
  • Check Status (outstanding/cleared)
• For check history by check number, press 3
  • Issue Date
  • Check Number
  • Check Amount (if applicable)
  • Check Status (outstanding/cleared)

Definitions of remittance codes, pricing for procedure codes and prior authorization inquiries: Press 6

• For remittance code information, press 1
• For pricing of a procedure code, press 2
• To determine if a procedure code requires prior authorization from Medicare, press 3

Enrollment information: Press 7

• For status of an enrollment application, press 1
• For a summary of applications and when to use them, press 2
• For a summary of documents required for certain specialties, press 3
• For mailing address and PECOS internet enrollment information, press 4
• For open enrollment and participation in Medicare information, press 5
• For a summary of enrollment information available on our website, press 6

Repeat menu: Press 8

This option returns callers to the main menu

End call: Press 9

This option ends the call in the IVR.

Additional information

Customer service representatives -  Medicare Part B

• 8 a.m. to 4 p.m. Monday through Friday, ET / CT*, excluding holiday closings and trainings.

* CT only for providers in Florida

• Toll-free telephone numbers: 

  • Florida / U.S. Virgin Islands: 1-888-454-9007 (TTY: 711)
  • Puerto Rico: 1-877-908-8433 (TTY: 711)

Training hours 

The First Coast Medicare Part B provider call centers are typically closed for staff training purposes on Thursdays from 2 p.m. to 4 p.m., ET. View the full training schedule. 

General written inquiries

Online submission: Medicare program-related inquiry

Website links

For additional information, visit the CMS website.