Last Modified: 5/3/2019
Location: FL, PR, USVI
Business: Part A, Part B
A provider may submit a waiver request to their Medicare Administrative Contractor (MAC) claiming an “unusual circumstance” outside of their control prevents the submission of electronic claims. It is the responsibility of the provider to submit the appropriate documentation including the following information:
• Provider name
• National Provider Identifier (NPI)
• Provider Transaction Access Number (PTAN)
• Practice location address
• Valid email address
• Phone number
• Signature of provider’s authorized or delegated official as reported in the CMS 855 enrollment application
This information will be used to establish the validity of the request. Requests received without documentation, and the above stated information, will be denied by First Coast Service Options (First Coast). If First Coast agrees the waiver request has merits, First Coast will send the request to the Centers for Medicare & Medicaid Services (CMS) for review and issuance of a final decision.
If First Coast does not consider the request as an “unusual circumstance”, and does not recommend CMS’ approval, First Coast will issue a response to the provider.
If a provider feels their situation merits an unusual circumstance waiver request, the provider may submit their request to:
Post: First Coast Medicare EDI
PO BOX 44071
Jacksonville, FL 32231-4071
Source: CR 10559
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.