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First Coast has seen an increase in claims for drugs, hemophilia clotting factors, and skin substitutes that exceed the dollar amounts above $99,999.99. Effective for claims received on or after November 6, claims missing the required infor…
There could be several reasons why your claim was denied or otherwise did not process successfully. Use these available resources to identify claims processing codes.
Read this article for tips on how to prevent RUC CO 16.
Pass-through status is determined for newly FDA-approved drug and device products on an individual basis. Review this article for more details on pass-through devices in an ambulatory surgical center (ASC).
Payment for ambulatory surgical centers (ASCs) are made under a separate payment system. As such, certain modifiers are specific to ASCs. This article explores these modifiers.
View this information regarding ANSI code OA-18.
CARC 22 - This care may be covered by another payer per coordination of benefits. This denial was received because Medicare records indicate that Medicare is the secondary payer.
Read this article for tips on how to prevent claim adjustment reason code (CARC) PR 49.
Duplicate claim denials continue to be one of the top billing errors. Duplicate submission of Medicare claims causes an increase in cost, valuable time, and resources for you, as well as First Coast.
The JW and JZ modifier policy applies to all drugs separately payable under Medicare Part B described as supplied in a “single-dose” containers. Read this article to understand how these modifiers should be billed.