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The claims value in dispute must meet the threshold for obtaining an administrative law judge (ALJ) hearing and a judicial review in federal district court. This is called the “amount in controversy.” The amount in controversy is recalculat…
This edition includes information for critical access hospitals, skilled nursing facilities, inpatient psychiatric facilities, and more.
Review this information for details on the 2026 enrollment application fee.
Before you request a redetermination on a denied claim, review these tips to avert delays in payment and save some valuable time.
Read the fourth quarter edition of the CERT Insider's Guide to learn more about the CERT program and the improper payment rate calculation.
Read this article for information about the CERT comparative analysis reports.
Part A and B providers can easily submit their Prior Authorization Request (PAR) forms in SPOT for certain hospital outpatient department services.
This edition includes information on the new CMS LEAD model, the new BALANCE model, 2026 updates, and more.
Are you sending hardcopy mail to submit your requests to First Coast? Did you know there are faster and easier ways to send your requests to us? Avoid the wait. Learn about the electronic options available for you to submit Part A appeals a…
In September 2025, a multi-jurisdictional evidentiary Contractor Advisory Committee (CAC) convened to review the clinical evidence and expert perspectives on coronary intravascular lithotripsy (IVL).