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Last Modified: 9/1/2009
Location: FL, PR, USVI
Business: Part B
Overpayment redetermination requests
To ensure efficient processing of overpayment redetermination request please complete the appropriate Overpayment redetermination request for a Medicare Part B claim form and mail to the post office box identified on the form.
Florida providers
Click to access the Overpayment redetermination request form for a Medicare Part B claim for Florida 
. Mail the completed form with supporting documentation to:
. Mail the completed form with supporting documentation to:Medicare Part B Overpayment Redetermination
P.O. Box 45248
Jacksonville, FL 32231-0018
P.O. Box 45248
Jacksonville, FL 32231-0018
Puerto Rico providers
Click to access the Overpayment redetermination request form for a Medicare Part B claim for Puerto Rico . Mail the completed form with supporting documentation to:
. Mail the completed form with supporting documentation to:Medicare Part B Overpayment Redetermination
P.O. Box 45015
Jacksonville, FL 32232-5015
P.O. Box 45015
Jacksonville, FL 32232-5015
U.S. Virgin Islands providers
Click to access the Overpayment redetermination request form for a Medicare Part B claim for the U.S. Virgin Islands . Mail the completed form with supporting documentation to:
. Mail the completed form with supporting documentation to:Medicare Part B Overpayment Redetermination
P.O. Box 45091
Jacksonville, FL 32232-5091
P.O. Box 45091
Jacksonville, FL 32232-5091
Completion of the Overpayment redetermination request for a Medicare Part B claim form and addressing the request to the appropriate mailbox is critical to correct processing of your overpayment redetermination request. Using this form makes handling requests for overpayment redeterminations easier and more efficient for providers’ offices.
Note: Complete the Overpayment redetermination request for a Medicare Part B claim form if you are disputing an existing overpayment. If First Coast Service Options Inc. (FCSO) has not sent a demand letter requesting a refund of payment and you are notifying FCSO of an overpayment, you must complete the Overpayment refund form .
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