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Appeals
Clerical reopenings -- submit minor corrections outside of the appeals process online using SPOT, or by calling the IVR (Interactive Voice Response).
Medicare Part B PWK fax/mail/esMD coversheet -- 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.
EDI
EDI 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.
Immunization roster billing
Influenza virus vaccine roster -- here is a roster to use to capture patient information when creating an influenza virus vaccine roster.
Provider 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).
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.