Last Modified: 7/8/2022
Location: FL, PR, USVI
Business: Part A, Part B
First Coast continually looks for ways to improve the speed and service we provide you as an electronic billing customer. We are pleased to announce the new EDI TIBCO Gateway solution. This new EDI gateway replaced the Florida Blue EDI gateway connection to First Coast effective July 1.
The EDI Gateway transition impacts all electronic billing customers who connect to First Coast. First Coast administers the Medicare contract for jurisdiction N (JN). JN includes providers in Florida, Puerto Rico, and the U.S. Virgin Islands.
All Network Service Vendors (NSV) must establish the new connection to First Coast. Once the new connection is established, all EDI trading partners may begin submitting electronic claims through the new TIBCO gateway.
The following information regarding the actions needed are specific to your method of connectivity as an electronic biller. Please follow the actions needed for section appropriate to your connectivity method.
1. Update the SFTP connection following the SFTP connection section details below.
2. Verify that the Interchange Receiver ID (ISA08) contains the contract ID for all 837 and 276 claim files. Please work with your software vendor to update the ISA08 prior to submitting claims over the New TIBCO EDI Gateway. Provided below are the First Coast contract IDs based on region.
• Medicare A Florida: 09101
• Medicare A Puerto Rico/U.S. Virgin Islands: 09201
• Medicare B Florida: 09102
• Medicare B Puerto Rico: 09202
• Medicare B U.S. Virgin Islands: 09302
3. Retrieve the TA1, 999 and 277 claim acknowledgement reports from the new TIBCO gateway after sending files to the new TIBCO gateway.
After being systematically migrated to the new TIBCO connection, you will receive a rejection on the TA1 report if any files are sent to the Florida Blue gateway.
The 835 electronic remittance advice and 277 claim response reports will be available on both EDI gateways. You will see duplicate files if you download from both gateways. Be sure to only retrieve reports from the new TIBCO gateway after migrating.
NSV - update the host name used when connecting to First Coast.
Providers, Billing Services, and Clearinghouses:
1. Set up your initial password.
• Enter your Mailbox ID.
• Enter the initial password, which is assigned as Fcs#LLLL where LLLL represents the last 4 characters of your submitter ID.
• Enter a new password.
• Enter the new password a second time to confirm.
• Click Submit. A message will indicate that your password has been successfully updated.
2. Confirm your Network Service Vendor (NSV) has updated the connection host name.
3. Once confirmed, connect to First Coast using your NSV product. Enter your current Login ID and the new password that you created in step 1.
4. Upload 837 files to:
• /outbox/X12/EDI/Inbound/Interchange for X12 files
• /outbox/EZComm/BC/1.0/Notify for ZIP files
5. Retrieve the ANSI X12N 999 report response from:
• /inbox/X12/EDI/Outbound/Interchange for X12 files
• /inbox/EZComm/BC/1.0/Notify for ZIP files
Note: If the 999 is not available, retrieve the ANSI X12N TA1 file, correct the errors and resend the ANSI X12N 837 file until accepted. The TA1 report location is: /inbox/X12/00501/EmptyGroup/TA1
• The 999 and 277CA reports will only be sent to the Gateway receiving the file. This means if you are submitting files via the current Florida Blue Gateway, you will retrieve these electronic reports from the Florida Blue Gateway. If you are submitting files via the new TIBCO Gateway, you will retrieve these electronic reports from TIBCO.
• The 835 and 277 files that are sent in response to production 837 files will be sent to both Gateways for retrieval (Florida Blue and TIBCO).
6. Open the ANSI X12N 999 file and interpret the report. If rejected, please correct the errors and resend the ANSI X12N 837 file until accepted.
Note: When opening files for the first time, you may need to choose a basic text editor program from your computer such as notepad. If you choose a program like Adobe or Internet Explorer, you will receive error messages indicating the file will not open. A text editor program must be chosen for these reports. If your browser defaults to a program that will not read the file, the browser settings will need to be updated to choose a text editor program.
7. After receiving an accepted ANSI X12N 999 report, retrieve the ANSI X12N 277CA report from the same location as the ANSI X12N 999 report indicated in step 5.
8. Open the ANSI X12N 277CA file and interpret the report.
9. Continue to send all 837 electronic claim files and retrieve all electronic reports through the new gateway connection.
10. Contact your NSV with any questions or concerns with the new gateway connection.
• There are no changes to how you connect to SPOT.
• There will be no changes with the DDE connection.
• Refer to the HTTPS CAQH CORE Connectivity Guide for updated information.
If you have any questions related to this change, please contact EDI at 888-670-0940, Monday-Friday, 8 a.m. - 5 p.m. ET.
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.