The Centers for Medicare & Medicaid Services (CMS) implemented billing instructions for providers to resubmit as ancillary (type of bill 12x) and outpatient (type of bill 13x) claims when the inpatient services were denied by the recovery audit contractor (RAC).

In May 2008 First Coast Service Options Inc. (FCSO) identified that outpatient claims (TOB 13x) were rejecting as duplicates of inpatient claims previously denied by the RAC. The inpatient claims were denied because the services provided did not support admission into an inpatient stay. FCSO has been investigating the issue and has implemented a system solution that will allow processing of outpatient (TOB 13x) claims. Providers may now begin re-filing their claims.

When re-filing your claims, you must indicate a comment as follows:

In the blank space, you must denote the DCN of the inpatient claim. Please note; no abbreviations can be used within the comment statement. It must be stated as exactly noted above.

Recently it has been identified that the 837 electronic claims format does not provide enough space to allow the full comment noted above to be entered. Therefore, we are modifying our instructions to allow those impacted providers to bill using the comment noted below:

Failure to include the above comment exactly as written will result in your claims being rejected.