November 10, 2008
Top Part B inquiries for September 2008
Would you like to reduce the time you spend contacting Medicare? Below are the inquiry topics received most frequently by the Part B provider contact center during the month of September 2008, as well as tips and resources to help you avoid or reduce the amount of time spent on many of these issues. We will update this list each month.
Please remember to use the IVR for claim status, eligibility (Medicare, MSP and Medicare Advantage [formerly Medicare HMO]), deductible information, and financial information (last three checks, month/year to date dollar amounts). Contact the IVR by calling 1-877-847-4992. Refer to the Part B IVR operating guide for instructions.
Claim information change
This inquiry is related to providers requesting clerical error reopenings.
• Determine if the error can be corrected and resubmitted prior to writing in or calling to request a clerical error reopening.
• Ensure to review the type of clerical error or omission you are attempting to correct and select the most efficient option available.
• Resubmitting claims to correct minor clerical errors or omissions is the most efficient method for addressing certain denied services.* If clerical reopenings are received via written and telephone requests, it may take up to 60 days to process and finalize the adjustment to the claim, versus 14-30 days for a resubmitted claim.
• *Resubmit ONLY the denied service(s) - resubmitting an entire claim will create a duplicate denial.
• Minor clerical errors or omissions which can be corrected and resubmitted:
• Change of diagnosis codes
• Add, change, or delete modifiers (i.e., 24, 25, 50, 59, 78, 79, RT, LT)
• Incorrect place of service
• Written or telephone clerical error reopenings are appropriate only for correcting services that were processed and received an approved amount, and could include the following types of situations:
• Units or number of services (NB) billed
• Submitted charge amount
• Date of service (DOS)
• Add, change or delete certain modifiers
• Procedure code (excluding codes requiring documentation on the initial submission or codes being upcoded).
(Last Modified 9/12/08)
Provider enrollment inquiries
• Status of application – To check the status of an application, providers should contact the IVR by calling 1-877-847-4992. The provider Interactive Voice Response unit (IVR) menu has been enhanced with the ability to check an enrollment application’s status. The following enrollment application status information can be provided:
• Finalized – application is denied, rejected, or returned.
• Pending – application has been processed and is pending for approval.
• Returned development – application is processing; however, additional information is needed.
• Approved – application was approved and finalized.
• Merged – application has been merged with another application.
• Refer to the Part B IVR operating guide for instructions.
.• Request for an enrollment application – To access the appropriate CMS-855 enrollment application, please visit the following Web address: http://www.cms.hhs.gov/MedicareProviderSupEnroll/02_EnrollmentApplications.asp 
• General questions on filing applications – Several articles and helpful tip sheets explaining how to complete the applications, as well as general information concerning enrollment, are available on the Provider Enrollment Web page.
• Also, a new process has been established whereby calls relating to provider enrollment or debt collection may be given more comprehensive service.
• Once you have conducted your initial research into your matter, call Part B customer service’s toll-free line (1-866-454-9007) for additional assistance.
• Note: Effective October 1, 2008, the provider contact center no longer accepts calls concerning pending provider enrollment applications from anyone other than the contact person listed on the application.
• If a FCSO representative determines your provider enrollment (or debt collection) issue requires more in-depth research and assistance, he or she will assign a referral number and provide a new toll-free number for the extended service line. You must go through this process to access the extended service line.
• Call the toll-free number and supply the assigned referral number.
• You will then work directly with a representative from the appropriate operational area to resolve your issue.
(Last Modified 10/02/08)
Coding errors/modifiers/global surgery
• Multiple Web-based training (WBT) modules are available free of charge via the FCSO Learning Management System at www.fcsomedicaretraining.com :
:• Introduction to Global Surgery – Part B
• Modifier 24 – Part B
• Modifier 25 – Part B
• Modifier 58 – Part B
• Modifier 78 – Part B
• Modifier 79 – Part B
(Last Modified 9/12/08)
Appeals – status/explanation/resolution of an appeal request other than a QIC appeal
• A WBT titled “Appeals Process - (Florida Part B)” is available free of charge via the FCSO Medicare training Web site at www.fcsomedicaretraining.com .
.(Last Modified 9/12/08)
MSP (Claims denied for other insurance as Primary)
• Use the Medicare Secondary Payer (MSP) Questionnaire to determine Medicare primary or secondary status.
• Check patient’s eligibility, including if Medicare is a secondary payer, via the IVR. Contact the IVR by calling 1-877-847-4992. Refer to the Part B IVR operating guide. for instructions.
• If Medicare is secondary, the IVR will advise MSP details, including 1) Type of primary insurance and 2) Effective and termination date for all valid Insurers for a current or previous date of service.
• Contact the patient to determine if any change has occurred in their insurance status. If so, update the insurance information on your files for all future claims.
• You may contact the Coordination of Benefits Contractor (COBC) and update the patient’s files by conducting a conference call with the patient. You may reach the COBC at (800) 999-1118.
• Complete the free WBT titled “Medicare Secondary Payer (MSP) Beyond the Basics - Florida Part B” via the FCSO Medicare training Web site at www.fcsomedicaretraining.com .
. (Last Modified 9/12/08)
Release of eligibility information to providers
• You may now check current eligibility for beneficiaries, as well as eligibility for a previous date of service, using the IVR. Contact the IVR by calling 1-877-847-4992. Refer to the Part B IVR operating guide for instructions.
(Last Modified 7/9/08)
• Check claims status though the IVR. Contact the IVR by calling 1-877-847-4992. Refer to the Part B IVR operating guide for instructions.
• The IVR will advise the complete details regarding a claim, including the specific reason a claim may have denied.
• If submitting paper claims, allow time for FCSO to receive, scan, and enter claims into the system.
• Allow at least 45 days from the date of receipt for pending claims to finalize. If the claim has not finalized in 45 days, call Part B customer service’s toll-free line (1-866-454-9007) for additional assistance.
(Last Modified 10/29/08)
Duplicate claims
• Check claims status though the IVR. Contact the IVR by calling 1-877-847-4992. Refer to the Part B IVR operating guide for instructions.
• If submitting paper claims, allow time for FCSO to receive, scan, and enter claims into the system. Claims should not be resubmitted before 45 days, to allow for complete processing.
• Allow at least 45 days from the date of receipt for pending claims to finalize. If the claim has not finalized in 45 days, call Part B customer service’s toll-free line (1-866-454-9007) for additional assistance, before resubmitting the claim.
• If a clerical reopening has been requested, it may take up to 60 days to process and finalize the adjustment to the claim. Allow the reopening to finalize and do not resubmit claims during this time.
• If resubmitting claims to correct minor clerical errors or omissions, be sure to resubmit ONLY the denied service(s).
• Resubmitting an entire claim will create a duplicate denial.
• Also ensure appropriate modifier(s) are on claim lines.
• Complete the free WBT titled “Duplicate claims – Part B” available via the FCSO Medicare training Web site at www.fcsomedicaretraining.com .
.(Last Modified 9/12/08)
Claim denial
• See Claim Status instructions above.
(Last Modified 10/29/08)
