Effective March 1, 2010, First Coast Advantage (FCA) Service Alert: Medicaid Paper Claims Submission Policy:

 

On January 22, 2010, The Agency for Healthcare Administration (AHCA) provided First Coast Advantage (FCA) with an Updated Paper Claims Submission Policy.  The Policy includes Pricing By-Report Procedures, Medical-Surgical, Medical Necessity and DME Procedure Code Pricing. This Paper Claims policy was being performed by EDS Medicaid's Fiscal Agent. 

Effective March 1, 2010, this process will now be the responsibility of FCA. Any services that require Pre-authorization by FCA will still be required. Any paper claims for inpatient or outpatient services that are submitted and fall under the Paper Claims Submission Policy must have the appropriate documentation required for submission to FCA TPA (APEX Benefit Services).

If a provider fails to follow the outlined paper claims process for submission on the Service Alert for By-Report Procedure, Medical Surgical, Medical Necessity or DME pricing, the claim will be denied and the provider has the option of filing an appeal and providing the appropriate documentation. 

FCA Appeals process can be found on the FCA Website at www.firstcoastadvantage.com under Provider Information / Claims Information and in the FCA Provider Manual under Section 20 Claims. The Paper Claims Submission Policy Service Alert is posted on the FCA website under Service Alert and for questions you can call FCA Provider Services at 1-866-270-2468.