|
Last Modified: 2/10/2012
Location: FL, PR, USVI
Business: Part A, Part B
Selecting the appropriate EDI enrollment form to use
The processing of EDI enrollment forms can take First Coast Service Options Inc. (FCSO) up to five business days to complete. If the request is approved, a confirmation letter is returned to the provider via U.S. Mail. If the request is denied, the original paperwork is mailed back to the provider. Two examples of why a request would be denied are: An invalid NPI is used on a form or a mismatch between the address listed on the form and the one on file.
The mailed response from FCSO can take 5-10 days to be delivered depending on the provider’s location. Please allow ample time for processing and mail delivery before calling the EDI help desk for a status.
Choose the correct EDI enrollment form(s) listed below based on your respective needs:
EMC change of information
• Adding/deleting a provider from an existing sender to submit claims
• Change of submitter address, contact, or e-mail address
• Deleting an existing sender number
to access the EMC change of information formEDI enrollment
• Must be completed before submitting claims electronically (EMC) for the first time
New installation / change of vendor
• Providers, billing services, or clearinghouses who want to begin submitting claims electronically
• Existing electronic submitters that are changing software support vendors
• Existing submitters adding an additional Medicare line of business
Electronic data request
• Applying for or revising existing information for the ANSI X12 835 electronic remittance advice (ERA)
• Applying for or revising existing information for the ANSI X12 276/277 electronic claim status request and response (ECS)
• Note: Before applying for either transaction, please ensure you have the necessary software to conduct the transaction.
Click here to access the EDI enrollment forms page.
