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Last Modified: 10/14/2021 Location: FL, PR, USVI Business: Part B

Submit Part B claims and correct claims billed in error 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?

Submitting a claim electronically

CMS requires providers to submit their claims electronically. Please see the CMS IOM Pub. 100-04 Claims Processing Manual, Chapter 24, section 90 external pdf file concerning the mandatory requirement for electronic claims submission.
If you want to ease into electronic billing, First Coast offers the following software programs:

Electronic Submission Method

Submission Instructions

Additional Resources

PC-ACE
Refer to PC-ACE Software for technical requirements, enrollment, software installation, claim entry and transmission instructions.
Billing service/ clearinghouse
Third-party billing service or clearinghouse submitting claims on behalf of provider.
Refer to Provider guidelines for choosing a vendor for further assistance.
Visit our Approved Vendor List for further information.

Correcting a claim billed in error

Claims billed in error may be corrected electronically using SPOT or the Reopening Gateway. Use the Billed in Error feature to report paid claims, or individual lines of a claim, as billed in error. The claim must finalize prior to reporting the claim or line item(s) as billed in error.

Electronic Submission Method

Submission Instructions

Additional Resources

SPOT
To perform a claim correction using SPOT, select the Reopening/correct a claim option from the Appeals option on the SPOT toolbar. Then select Overpayment correction.
To learn more and enroll for SPOT, view:
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 (MRA), since protected health information will not be retrieved and displayed from the Medicare processing systems.
To learn more, visit the Reopening Gateway and the help guide.
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.