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First Coast Service Options Inc.
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Last Modified: 6/15/2010 Location: FL, PR, USVI Business: Part A, Part B

Updated electronic data request form now available

An updated electronic data request (EDR) form pdf file that allows for multiple National Provider Identifiers (NPIs) to one provider identifier number and one provider identifier number to multiple NPI combinations is now available. In addition, the new form may be completed online (except for the signature) and then printed out for you to sign and fax to Medicare EDI. Do not use any locally-stored forms -- you should always obtain the form from the link above to ensure you have the current version. Effective June 15, 2010, any EDR received on the old version will be returned to the provider.
Please contact EDI enrollment at 888-670-0940 option 4 if you have any questions.
First Coast Service Options (FCSO) strives to ensure that the information available on our provider Web site is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.