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Last Modified: 10/27/2021 Location: FL, PR, USVI Business: Part B

Submit Part B 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?
• First level - redetermination
• Clerical reopening request

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:
• Submit using the Medicare Part B Redetermination and Clerical Error Reopening Request form.
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 Submit an Appeal from the Appeals submenu from the SPOT toolbar.
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 904-361-0595
• 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.

Clerical 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 Submit an Appeal from the Appeals submenu from the SPOT toolbar.
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.
Reopening gateway
The Reopening gateway is a free self-service tool that does not require enrollment.
This tool is a web-based application that allows the automated submission of claim corrections, billed in error requests, and history corrections.
The application is designed to be used in conjunction with the Medicare remittance advice, since protected health information will not be retrieved and displayed from the Medicare processing systems.
To learn more, visit our Reopening gateway webpage and the help guide.
Interactive voice response (IVR) system
The enhanced IVR claim correction self-service tool offers the following:
• Designed to make your requests easier and faster to process. Requests for telephone reopenings via the IVR will process the next day.
• Using this self-service feature will result in faster receipt of any applicable payments.
• The house of availability are beyond the hours of availability for customer service.
To learn more about the IVR, visit our IVR resources webpage.
First Coast offers free education on the submission methods described above. Access the following to learn more:
• Live Events calendar
• Learning On Demand education
Back to the Avoid the wait home page to explore more topics and options for electronic submission:
• Part A Avoid the wait
• Part B Avoid the wait
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.