Claims resubmitted after a clinical review of records

A billing issue has been identified by the First Coast Service Options Inc. (First Coast) routine data analysis process with claims that have been previously reviewed clinically and are being resubmitted as new. A claim that has been clinically reviewed and/or denied should never be resubmitted as a new claim but must be submitted as an appeal request. First Coast views this as an abuse of the process and is implementing Part B claim processing edits to deny the resubmitted claim.