Advance payment – Part B only

Advance payment is the contractor’s conditional partial payment to a provider on a Medicare Part B claim the contractor is unable to process within the dictated time limits (i.e., claim system problems, etc.).

Email your request to AAP-FCSO@fcso.com.

When an advance payment is requested, the contractor will review the reason for the request. The request must include (42 CFR §421.214):

• A written request from the provider with detailed information supporting the reason for delayed payment is due to the contractor’s processing error.
• The amount the provider is requesting for payment.

First Coast must confirm that the provider:

• Is not under Medical Review or Program Integrity Investigation;
• Has no outstanding Medicare overpayments;
• Has not been delinquent in repaying outstanding overpayments involving Medicare claims;
• Accepts assignment on all claims submitted within the past 180 days preceding the request or system malfunction;
• Agrees to the offset of all future claim payment(s); and
• Maintains assignment on claims submitted during the processing issue equal to or greater than the rate of the 180-day period prior to the request.

If the above is valid, the contractor can proceed processing the advance payment request. All advance payments are calculated at no more than 80% of the historical assigned claim payment data. This historical data represents a 90-day claim payment trend within the previous 180 days.

A letter is sent to the CMS Regional Office to request final approval of the advance payment.

Upon receiving CMS’ response of concurrence or disapproval, the provider is notified immediately.