Find information regarding the appeals process -- levels, forms, training, FAQs, and how to appeal Medicare coverage and payment decisions.
Find the latest news pertaining to Medicare billing and general coverage changes, learn how to employ preventive measures to promote patient health, use tools to improve your billing, and locate deductible information.
Features key resources to help you understand claim submission guidelines and current processing issues and how they may impact you. It also includes essential information that will help you decrease the time you need to spend calling the provider contact center and increase the volume of claims that process correctly -- the first time. You’ll be able to review the top inquiries, denials, and return unprocessable claims (RUC) (or Inquiries, Rejects, and RTPs) and learn how to avoid them.
CMS has implemented several review programs to ensure that all Medicare claims are billed and paid correctly in accordance with the law. This section will enable you to find the information you need about medically unlikely edits (MUE), comprehensive error rate testing (CERT) program, the recovery audit contractor (RAC), and National Correct Coding Initiative (CCI) edits.
Find resources to improve your coding accuracy and keeps you informed on coding-related topics including ICD-10, modifiers, place of service, and procedure codes
Find telephone numbers, departmental contact information, holiday and training closures, how to submit general inquiries and provide feedback to First Coast, additional resources, and more.
Find the latest Electronic Data Interchange (EDI) news, software updates, forms, pre-pass edits, and companion documents and learn how to begin submitting your claims electronically.
Learn about First Coast’s online and instructor-led training opportunities; get involved with the Provider Outreach and Education Advisory Group (POE-AG); and find links to the educational resources available on the Centers for Medicare & Medicaid Services (CMS) website.
Learn more about billing for evaluation and management (E/M) services including its key components, CPT code ranges, and documentation requirements. You’ll also find helpful tips, tools, and information regarding other online E/M resources available to providers.
Find answers to your questions regarding billing issues, drugs and biologicals, coding inpatient cost outlier claims, eligibility, skilled nursing facilities, provider enrollment, overpayment, claims overlap, and more.
Use our interactive fee lookup tool, download data files containing the most recent fee schedule information to use in developing a database of fees, and search our extensive archive of retired fee schedules.
Providers can use the forms on our new feedback page to submit comments regarding their interchange with various operational areas throughout First Coast Service Options Inc. and to submit comments related to this website and its functionality.
Find the forms you need for an overpayment refund request, extended repayment schedule for corporations or groups, overpayment redetermination request, periodic interim payment request, an influenza virus vaccine roster, or a credit balance report.
Find various help documents, how-to guides, and resources on disaster information. Here you can also access MEDPARD information, find updates on the Medicare Modernization Act (MMA), learn how to prevent fraud and abuse, and more.
Find the latest news and information identified specifically for providers of specialty services including ambulance, end-stage renal disease, hospital, rehabilitation services, skilled nursing facilities, and several more.
Learn how to use our interactive voice response system for 24-hour access to general information regarding new Medicare legislation, office closures, publications, remittance code definitions, and other information. The IVR can also help you access eligibility and claim specific information during hours beyond customer service availability.
Find news about local and national coverage determinations, learn how to search the Medicare coverage database, search for LCDs, and review clinical trials.
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.
Medical Review focuses on identification of aberrancies or patterns of inappropriate billing, educating providers on Medicare coverage and coding requirements, and performing medical review of claims and supporting documentation. Learn more about the medical review process including the Targeted Probe and Educate program, as well as the Prior Authorization program.
Get the latest news regarding provider audit and reimbursement, along with forms for interim rate and periodic interim payment requests as well as statistical and reimbursement report fax sheets.
Find links to the home health prospective payment system as well as updates to psychiatric, long-term care, and hospital outpatient and inpatient systems.
Find the latest provider enrollment news as well as the forms, tools, and resources you need to become a Medicare provider and learn how to successfully complete enrollment forms the first time with helpful tips and tutorials.
Learn the latest news, information, and eligibility requirements for the Centers for Medicare & Medicaid Services’ (CMS) incentive programs that help improve the quality and efficiency of beneficiary care through provider participation.
Medicare A Connection is First Coast’s comprehensive, monthly Medicare publication for Part A health care providers located in Florida, Puerto Rico, and the U.S. Virgin Islands. Each issue keeps you informed of changes to the Medicare program and includes a detailed review of First Coast and CMS’ articles published during the featured month. Explore our library of current and past editions.
First Coast’s Secure Provider Online Tool (SPOT) is a free web-based application hosted through the Centers for Medicare & Medicaid Services’ Enterprise Identity Management (EIDM) portal. The SPOT offers providers the convenience of online access to essential Medicare data, including claim status, payment history, benefits/eligibility information, and data reports. It also serves as an alternative submission channel for additional development response (ADR), appeal, overpayment, and reopening forms.
This page features a one-stop shop for all of First Coast’s self-service tools.
New providers -- begin your Medicare journey the right way with First Coast’s Right Start program.
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.