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Last Modified: 9/16/2022 Location: FL, PR, USVI Business: Part A

Submit Part A appeals and claim corrections electronically

Are you using regular mail for submissions to First Coast? We have several electronic options that are easier and faster for you to use. Additionally, submitting documentation electronically:
Saves time, electronic submission eliminates mailing delays
Eliminates administrative costs, electronic submission costs nothing
Protects patient information, electronic submission is secure
Allows for the immediate confirmation of receipt, electronic submission provides transaction confirmations
Read on to find out how you can avoid the wait by submitting electronically.
What are you trying to submit to First Coast?
Appeal:

First level appeal (redetermination)

An appeal is a new and independent examination of a claim due to dissatisfaction with the initial claim determination.
A redetermination request is the first level of the appeal process and is sent to the MAC who processed the claim. A provider has 120 days from the receipt of the claim determination notice to file a redetermination request:
Electronic submission of an appeal request to First Coast can be performed using the following methods:

Electronic Submission Method

Submission Instructions

Additional Resources

SPOT
SPOT is a FREE, secure internet portal for Part A and B customers to use to easily connect directly to First Coast. SPOT provides quick access to a number of time-saving features.
To submit a redetermination request, select the Appeals Requests/Outcome from the Appeals submenu from the SPOT toolbar and then select the Submit an Appeals button.
To learn more and enroll for SPOT, visit the SPOT webpage and view the article How to use SPOT to submit appeals and check status.
Fax
The fax to image option allows for documentation to be submitted directly to First Coast:
Fax to 904-361-0593
Faxes should not exceed 200 pages
Complete the form in its entirety
Send all supporting documents for service(s) rendered
For more information and to access the fill and print redetermination form, visit the Appeals webpage.
esMD
The esMD portal allows providers and suppliers to securely submit electronic medical documentation for first and second level appeals.
To sign up for esMD, visit Electronic Submission of Medical Documentation (esMD) on the CMS website.

Second level appeal (reconsideration)

A reconsideration request is the second level of the appeal process and should be sent to the Qualified Independent Contractor (QIC), not the MAC. A provider has 180 days from the receipt of the redetermination notice to file a reconsideration request:
Electronic submission of an appeal request to the QIC can be performed using the following methods:

Electronic Submission Method

Submission Instructions

Additional Resources

SPOT
SPOT is a FREE, secure internet portal for Part A and B customers to use to easily connect directly to First Coast. SPOT provides quick access to a number of time-saving features.
To submit a reconsideration request, select the L2 – Reconsideration Request link from the claim status page.
To learn more and enroll for SPOT, visit the SPOT webpage.
Appeals Portal
For instructions on using the C2C appeals portal, please refer to the Access a User's Guide.
Fax
For secure electronic submission of standard appeals, fax to QIC Part A East for all regions:
904-539-4074
To learn more about C2C Innovative Solutions, review the web page for QIC Part A East.
esMD
The esMD portal allows providers and suppliers to securely submit electronic medical documentation for first and second level appeals.
To sign up for esMD, visit Electronic Submission of Medical Documentation (esMD) on the CMS website.

Claim reopening request

A claim reopening request can be submitted to the MAC for claim submission error(s) or inaccurate data entry to request an adjustment to the initial claim submission.
A claim reopening request must be submitted to the MAC within one year from the initial claim determination:
Electronic submission of claim reopening requests to First Coast can be performed using the following methods:

Electronic Submission Method

Submission Instructions

Additional Resources

SPOT
SPOT is a FREE, secure internet portal for Part A and B customers to use to easily connect directly to First Coast. SPOT provides quick access to a number of time-saving features.
To submit a redetermination request, select the Appeals Requests/Outcome from the Appeals submenu from the SPOT toolbar and then select the Submit an Appeals button. You must include the UB-04 claim form with documentation to support an override exception.
To learn more and enroll for SPOT, visit the SPOT webpage.
Fax
The fax to image option allows for documentation to be submitted directly to First Coast:
Fax to 904-361-0593
Faxes should not exceed 200 pages
Complete the form in its entirety
Send all supporting documents for service(s) rendered
For more information and to access the fill and print redetermination form, visit the Appeals webpage.

Claim correction

Claim submission errors may necessitate the need for a correction, an adjustment or a cancel and rebill of the initial claim submission.
Claim adjustment can be made directly by the provider to a processed or rejected claim:
Access claims corrections from the Fiscal Intermediary Standard System (FISS) Main Menu
Select your type of service/facility in the Claim Adjustments Menu
Claim correction is submitted as an XX7 type of bill (TOB)
Claim correction can be made directly by the provider to a return to provider (RTP) claim:
Access claims corrections from the FISS Main Menu
Select your type of service/facility in the Claims Corrections Menu
Update claim and F9 to store new data
Claim cancel can be made directly by the provider for a denied claim or to correct a denied line item that was billed with error(s) or inaccurate data entry:
Access claims corrections from the FISS Main Menu
Select your type of service/facility in the Claim Adjustments Menu
Claim cancel is submitted as and XX8 TOB
Allow claim to finalize and cancel before rebilling new claim
A claim correction must be done in accordance with Medicare guidelines for timely filing:
One year from the date of service for outpatient claims
One year from the date of discharge for inpatient claims
A claim correction can be performed using the following methods:

Electronic Submission Method

Submission Instructions

Additional Resources

FISS
Access to the FISS system allows customers to perform multiple billing functions such as keying claims via Direct Data Entry (DDE), checking claim status, performing claim corrections, and much more.
Visit our DDE webpage for more information on registering for and using DDE.
Free software
Medicare offers the following software programs:
PC-ACE - free billing software for creating claims and translating reports
PC-Print - free software for interpreting and printing the X12N 835 Electronic Remittance Advice (ERA)
Visit our Electronic data interchange (EDI) webpage to learn more about this software.
Billing service/clearinghouse
Providers can opt to have their claims sent to First Coast by a billing service or clearinghouse. Refer to the article A step-by-step guide to getting started submitting electronic claims for further assistance.
Visit our Approved 5010 vendor list for further information.
First Coast offers free education on the submission methods described above. Access the following to learn more:
Learning On Demand education
Back to the Avoid the wait home page to explore more topics and options for electronic submission:
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website 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.