Reopening requests for certain claims to be reprocessed under the Affordable Care Act no longer being accepted

In May 2011, First Coast Service Options (FCSO) began accepting fax requests for reopenings of claims with dates of service in January-May 2010 to be reprocessed under the Affordable Care Act (ACA). Since that time, mass adjustments have been executed that automatically reprocess claims where the billed amount was greater than the new (post-ACA) allowances. To reduce workloads and costs associated with manually reprocessing faxed requests, CMS has authorized contractors to stop performing manual reopening of those claims that are scheduled to be mass-adjusted. Therefore, effective July 15, 2011, FCSO will no longer accept fax reopenings of claims where the original amount submitted was sufficient to allow mass adjustments to provide additional moneys due as a result of the ACA changes. Providers continue to be required to request a reopening for claims containing services where the original amount submitted was less than the new ACA allowance, indicating that the billed amount should be increased to at least the new payment rate. First Coast Options: MAC for Jurisdiction 9, which includes Puerto Rico, the U.S. Virgin Islands and Florida