Wednesday, February 1, 2017

Claim not on file denial

Having problems locating a claim you submitted to First Coast Service Options (First Coast)?

Claim not on file inquiry

There are steps you can take to make sure your claim was received by First Coast.

1. Before contacting customer service, check claim status.

• Reminder: The interactive voice response system (IVR) and customer service access the same claims system database. If the IVR has no record of a claim, customer service will also have no record.

2. Electronic claims

If you have not received an acknowledgement, you may have received a reject notification. If you have received a reject notification, the batch of claims you submitted contains an error that must be corrected.

3. Paper claims

If you are submitting the claims through the paper process, please allow sufficient time for us to receive, scan, and enter claims into the system. This process could take up to seven business days.

4. If the claim is not on file and still within the timely filing limits, resubmit the claim.

Enrollee not eligible on DOS Claim will deny if the client is not eligible during dates of service billed.

Check enrollee eligibility status through MediCall to verify eligibility on the date of service being rendered. If the enrollee is not eligible no payment will be received from Virginia Medicaid. If upon verification you find that the client is now eligible on that date of service resubmit the claim.

Enrollee is covered by private insurance, refer to third party information of this R/A

Our system indicates that there is a primary carrier, which needs to be billed prior to Medicaid. This carrier is now listed on your remittance advice under the claims information for that particular client. Please refer to this other coverage information which should be billed as primary.

*NOTE: If the client states there is no other coverage then they will need to contact their case worker at the Department of Social Services to have this information corrected

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