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A step-by-step guide to getting started submitting electronic claims for providers
Last Modified: 8/5/2025
Location: FL, PR, USVI
Business: Part A, Part B
For physicians/suppliers/facilities considering submitting claims via Electronic Data Interchange (EDI), the following information outlines procedures related to getting started along with additional electronic features available to EDI providers.
1. Choose the method of claim file creation: Determine how your office will create the 837 electronic claim file. If your office already has a method of creating claim files, contact your current vendor first to discuss billing Medicare electronic claims to First Coast.
• PC-ACE – this software is used for claim creation and report interpretation. It is available as a free download to all EDI customers through First Coast. Please visit “
Getting Started with PC-ACE” for the technical requirements and additional information about this product.
• Vendor – many other software programs are available for creating electronic claim files. Refer to the article “
Choosing a Vendor” for instruction on vendor selection. Specific services and financial arrangements must be made between the provider and the vendor.
• Billing Service – third party entities that are available to create the electronic claim file for provider offices. Refer to the
approved vendor list for a list of billing services currently enrolled and approved with First Coast. Specific services and financial arrangements must be made between the provider and the billing service.
• Secure Direct Data Entry (DDE) (Part A only) – DDE allows providers to submit Part A claims directly in the claims processing system without creating an 837 electronic claim file. DDE also offers other Part A claim functions such as claim status and claim correction. Refer to the article “Getting started with DDE” for more information. 2. Choose the method of submission: Determine the method you will use to submit the electronic claim files. Evaluate the options below:
• Secure Provider Online Tool (SPOT) – a free, web-based application hosted through the secure CMS Identity Management System. First Coast provides direct help desk support and many online resources for SPOT.
• Secure File Transfer Protocol (SFTP) - contract with a Network Service Vendor (NSV) for direct connectivity to the First Coast EDI Gateway. For a list of established NSV’s, refer to the to the
approved vendor list. Specific services and financial arrangements must be made between the provider and the NSV.
• Clearinghouse – third party entities that are available to submit electronic claim files. Some of these entities also offer claim file creation. Refer to the
approved vendor list for a list of clearinghouses currently enrolled and approved with First Coast. Specific services and financial arrangements must be made between the provider and the clearinghouse.
• Hypertext Transfer Protocol Secure (HTTPS) Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules (CORE)-Compliant Connection – this technical method of submission required the purchase of a digital certificate from a trusted certificate authority. For details on this method, refer to the
First Coast HTTPS CAQH CORE complaint connectivity guide.
3.
Complete the proper form: Once you decide the method of submission, you will need to complete the following form:
• EDI SPOT Enrollment Form for provider offices 
: This form is an agreement mandated by the CMS to be completed by each provider requesting access to the SPOT online portal. This form is required for the initial SPOT setup with First Coast. Once this form is processed, the office approver will need to complete the registration process in the identity management (IDM) system. Complete this form if a third party such as a billing service will need access to your office information. The SPOT form has separate detailed
completion instructions and can be faxed, mailed, or emailed.
This form is only for providers. Clearinghouses and billing services needing access to SPOT should complete the
EDI SPOT Enrollment form for third-party organizations 
using the
third-party portal form instructions • Electronic Data Interchange (EDI) enrollment form 
: This form is an agreement mandated by the CMS to be completed by each provider. This form will allow you to receive a sender/submitter number, mailbox ID and a password, which allows you to access different applications. Complete this form if your office will perform the electronic billing. This form will also allow you to add a provider number to an existing sender code. Complete this form if a third party such as a clearinghouse will perform the electronic billing on your behalf. The EDI form has separate detailed
completion instructions and can be faxed, mailed, or emailed.
This form is only for providers. Clearinghouses, billing services, network service vendors and third party vendors should complete the
EDI Third Party Enrollment form using the
third-party form instructions.
• Each NPI/PTAN
affiliated group or solo combination must be enrolled for electronic billing prior to submitting claims. If your organization has multiple NPI/PTAN combinations, include one on the EDI Enrollment Form and attach a list of the additional NPI/PTAN combinations. The attached list must include the provider’s name, PTAN, NPI, and TIN of each provider listed.
• If you are requesting to be assigned a new submitter ID, you must indicate your software vendor. If the software vendor is not yet an approved software vendor with First Coast, the software vendor will need to submit the EDI Third Party Enrollment form for testing purposes only. Once testing is complete and passed, then you may submit the form to be assigned a submitter ID.
4.
Submit production claims: Providers may begin submitting claims electronically in the production environment if using SPOT or if your software vendor has been approved. If the vendor is not yet approved, they must complete the test requirements before you may submit production claims.
5.
Take advantage of other electronic applications available to providers billing electronic claims: The
999 initial acknowledgment and 277CA report must be retrieved after each 837 claim file submission to ensure the file was accepted. You can take advantage of other electronic applications that will assist you in maximizing your efficiency. These applications are listed in the order of provider needs.
• Initial Acknowledgement (999)
• Electronic receipt of claim submission Health Care Claim Acknowledgement (277CA)
• Electronic remittance advice (ERA) (835)
• Electronic claim status (ECS) (276/277)
All the electronic applications are like electronic claims submission in the fact that you will need to obtain the software application from your software support vendor. Medicare only makes the applications available for use and does not provide the actual software application.
If you have any questions concerning these “Getting Started Steps” or other electronic applications, contact Medicare EDI at 888-670-0940.
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.