Last Modified: 8/7/2024
Location: FL, PR, USVI
Business: Part A, Part B
SPOT is our free online portal full of many
great features including claim submission, claim status, and patient eligibility. The eligibility feature interfaces with the CMS HIPAA Eligibility Transaction System (HETS) to provide the most accurate and up-to-date information to display.
Once enrolled for SPOT, you can obtain all the patient’s eligibility information using these three steps:
1. Sign in to SPOT with your username, password, and security code.
2. Click “Check Eligibility” from the “Eligibility” top menu option.
3. Search for the patient’s information with their full name, Medicare Beneficiary ID (MBI), and date of birth. The date of service is also required but a wide range of dates may be used.
The eligibility information provided is organized by sections. Simply click the tab of interest to review the related information. Below are the tabs available with a summary of what details are shown in each:
• Eligibility – Part A/Part B effective and termination dates, inactive periods, ESRDS, Acupuncture benefits, and MDPP eligibility dates
• Deductibles/Caps – line of business, year, base amount and remaining deductible information; free services; coinsurance %; blood deductible; outpatient mental coinsurance; therapy cap; and rehabilitation sessions used
• Preventive – smoking cessation session info, preventive services listing, MDPP usage, COVID-19 immunizations, flu vaccinations, and cognitive services
• MSP – type of primary insurance, effective and termination date, diagnosis code, policy number, insurer name, and address
• MAP – Medicare advantage plan contract, plan name, plan type, effective date, termination date, bill option code, address, web address, and telephone number
• Hospice/Home Health – HHEH start and end date, DOEBA and DOLBA dates, patient status code, notice of admission indicator, provider number, contract name, contract number, home health certification/recertification, and hospice information
• Inpatient – hospital information, hospital stay dates, SNF information, SNF stay dates, and psychiatric information
• QMB – Medicaid enrollment date/type, Part A/B deductible info, deductible, inpatient, and SNF
• PBID – effective and termination dates
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.