While providers and facilities are required and expected to work together to resolve the billing issue, providers may occasionally require assistance from the MAC. In that case, 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:

No, the service-specific review is not the same as the TPE program. For additional details on TPE, please visit our TPE page.

What if you do not agree with First Coast's determination?

Read about what happens when First Coast attempts to contact you.

An overlap is when an incorrect claim is processed and posted to the Common Working File (CWF) resulting in claim overlap rejection(s) of subsequent claim(s) submitted by the same or a different provider. When more than one provider is involved, the providers must work together to resolve the error. Some overlapping claim examples include:

Yes, the Cost Outlier timetable example is designed to assist providers in determining if a claim qualifies as cost outlier. Prior to coding an inpatient cost outlier claim, first determine the diagnosis related group (DRG) cutoff date, by using the example timetable.

Definitions

View this article to see how the error rate is determined.