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Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
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This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
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Medical review

Targeted probe and educate
CMS has authorized First Coast to conduct reviews utilizing a targeted probe and educate (TPE) review process. View current and upcoming topics, schedules, documentation checklists, educational articles / resources and round results.
Prior authorization
Learn more about the prior authorization (PA) program, including the implementation of the PA program for certain hospital outpatient department (OPD) services.
Post-payment service-specific review
Medical review of claims helps to ensure that Medicare pays for services that are covered, correctly coded, and medically reasonable and necessary.
Medical documentation and checklists
Medical record documentation is required to record pertinent facts, findings, and observations about an individual’s health history including past and present illnesses, examinations, tests, treatments, and outcomes. Find tips, tools and resources for the documentation of clinical services provided to Medicare patients. Use the checklists to ensure you have met medical documentation requirements based on specific services.
Medical Review contacts
Contact the Medical Review mailboxes below for general medical review questions. It is monitored daily during regular business hours. Do not include any protected health information (PHI) or personally identifiable information (PII).
Comprehensive Error Rate Testing (CERT)
Contact the First Coast Service Options CERT team at QUESTCERT@fcso.com. Use this mailbox for general CERT questions or to check the status of a CERT review. It is monitored daily during regular business hours. Please be sure to include the CID and contract number or state. Do not include PHI or PII.
Quick clicks
SPOT is a free web-based application hosted through the CMS Identity Management (IDM) system. SPOT saves you valuable time by offering the ability to view medical review-related additional documentation requests (MR ADR), education details, submit a response with supporting documentation, and check MR ADR status. SPOT users can also view eligibility data, submit and view level-one appeals outcomes, check claim status, access remittance details, and more.
With today's transition to automation, it is even more important to ensure that your physical and mailing address information are kept current with your Medicare administrative contractor.
How satisfied are you with the Medical Review process?
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.