Last Modified: 11/26/2024
Location: FL, PR, USVI
Business: Part A, Part B
First Coast would like to remind providers that electronic data interchange (EDI) enrollment forms may be submitted via email or fax.
Due to delays with the USPS, providers and third-party billers are encouraged to submit forms electronically. Mailing forms could cause a delay in the processing time of your forms.
EDI forms are designed to be completed online and can be signed electronically. Below are the fastest methods for submission of your EDI forms:
• By fax to 904-361-0470
Always use the most recent versions of the form from our website. Older versions will be rejected. Please allow 10 business days before contacting the Electronic Data Interchange (EDI) department for a status of an application.
We are currently experiencing a much higher than normal inventory level of Electronic Data Interchange (EDI) enrollment forms (8292) and SPOT enrollment forms (8292P). Please be patient and expect a longer wait time for processing.
To ensure your forms are accurate at the time of processing and to decrease unnecessary duplicate form submissions, read and follow the below form completion details:
• Only one form is needed for claim submission (837) and electronic remittance advice (ERA) (835) requests. Do not submit separate forms for ERA changes.
• The
EDI Enrollment Affiliated Provider List
should be submitted with the enrollment form when enrolling more than one related group or solo practice providers. Using this list will save you time completing forms and reduce our inventory volume. More than one list, or a separate spreadsheet, may be submitted for more than 15 affiliated providers.
• A valid digital or an original signature is required. Do not submit forms with a stamped or typed signature (any font) and always verify the form is signed before it is submitted. This is a top reason for forms rejecting.
• Ensure all form requirements are met. Carefully review the form instructions prior to submitting. If any requirements are not met, the form will not be processed. You will receive the error details and need to resubmit a corrected form.
We are also seeing many duplicate forms which creates an unnecessary increase to the inventory and will delay processing even longer.
Do not submit duplicate forms. If you need status of a form, or you aren’t sure if your form was submitted, call the
EDI Helpdesk or the
SPOT Helpdesk. If you need status of more than five forms, submit an email request to
MedicareEDI@FCSO.com. Allow 1-2 weeks for a response when submitting the email request.
Avoid pitfalls when completing the EDI enrollment form. Submit your EDI enrollment form correctly the first time and avoid processing delays.
It can take up to ten days to process your EDI enrollment form. If the EDI enrollment form is rejected a new EDI enrollment form must be submitted. Avoid delays by ensuring the form is completed correctly the first time. Below are the top reasons the
EDI enrollment forms 
are rejected.
1. Provider name is incorrect. The legal business name of the group is required and must match the Medicare shared systems.
2. Incorrect Provider Transaction Access Number (PTAN) and/or National Provider Identifier (NPI). The provider name, PTAN, and NPI reported MUST match the information on file at Medicare for the group, not an individual member of the group.
3. Signature requirements not met: Signature is not a wet or electronic signature. Typed signatures are not accepted. Ensure the signature, printed name, date, and title is included.
4. Missing Network Service Vendor (NSV) name. The NSV is required when requesting a new submitter ID.
5. Software vendor missing or not approved. An enrolled billing software vendor is required when requesting a new submitter ID.
6. Request type not completed: Indicate the type of request. This section indicates the action to be taken on your EDI agreements.
7. Electronic Remittance Advice (ERA) selection is missing or inaccurate. ERA is a requirement for EDI enrollment. This box must be completed for all new electronic provider requests. The option to maintain the existing ERA setup cannot be selected for new electronic billers.
If any additional assistance is needed, please contact one of our EDI analysts via telephone at 888-670-0940 or via email at
MedicareEDI@fcso.com.
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.