skip to content
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.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
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 or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
Join eNews       En Español
Text Size:
YouTube LinkedIn Email Print
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]


Electronic submission
Avoid the wait, submit electronically
List itemMedicare Part A PWK fax/mail/esMD coversheet pdf -- Use this form for voluntary submission of supporting documentation with a version 5010 electronic claim - required for forms received on and after April 1, 2018.
List itemAvoid processing issues: Submitting the correct form is important -- Use the correct form today to avoid processing issues.
Direct Data Entry (DDE)
List itemEDI forms -- find the EDI forms you need to begin electronic submissions of claims as well as an electronic data request form to apply for or revise existing information pertaining to the Electronic Remittance Advice (ERA) and/or Electronic Claim Status (ECS) transactions.
List item Extended repayment schedule for a corporation or group form pdf -- this document is required to consider an extended repayment schedule request for a corporation or group.
List item Extended repayment schedule for sole proprietor form pdf -- this document is required for sole proprietors who wish to request an extended repayment schedule.
List item Return of monies voluntary refund form pdf -- use this interactive form when reporting overpayments.
List itemRequest for immediate offset pdf -- use this interactive form when requesting immediate offset of overpayments.
List item CAAP debt dispute requestpdf -- use this form for COVID-19 Accelerated and Advance Payment (CAAP) Debt Dispute overpayments.
List itemPARD forms -- find the forms you need to submit interim rate and periodic interim payment (PIP) requests as well as statistical and reimbursement report fax sheets.
Prior authorizations
List itemPrior authorization request (PAR) for repetitive scheduled non-emergent ambulance transports (RSNAT) Medicare Part B fax/mail coversheet pdf -- The supplier must submit the PAR before the service is provided to the beneficiary and before the claim is submitted for processing Learn more about the overall PAR RSNAT process.
List itemPAR hospital outpatient procedures Medicare Part A fax/mail coversheet pdf -- The hospital outpatient department (OPD), or provider on behalf of the hospital OPD, must submit the PAR for certain hosptial OPD services. Learn more about the overall PAR OPD process.
List itemPAR hospital outpatient procedures Medicare Part A expedited fax/mail coversheet pdf Note: This form should only be submitted if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function.
Provider enrollment
List itemProvider Enrollment forms -- Learn which forms meet your enrollment needs and how to submit them. Find links to required enrollment applications (CMS-855), Participating physician or supplier agreement (CMS-460), and Electronic file transfer (EFT) applications (CMS-588).
Secure provider online tool (SPOT)
SPOT enrollment forms
Update information
List item SPOT update form for organizationspdf (Add/remove NPI/PTANs within account)
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.