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. Information for Medicare beneficiaries is only available on the medicare.gov website.
En Español
Text Size:
Close
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]

PARD forms

Provider contact formcompressed file
Modified: 8/16/2018
This form is used by Medicare Part A providers who change the default or other contact who receives their interim rate, tentative settlement, NPR & NOC-PR determinations.
Interim rate request form - FQHC providerspdf file
Modified: 10/8/2018
This form is used by FQHC providers when requesting the initiation of an interim rate request. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
Interim rate request form - IPF PPS providerspdf file
Modified: 9/28/2018
This form is used by IPF PPS providers when requesting the initiation of an interim rate request. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
Interim rate request form - TEFRA providerspdf file
Modified: 9/28/2018
This form is used by TEFRA providers when requesting the initiation of an interim rate request. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
Interim rate request form for a hospitalpdf file
Modified: 9/28/2018
This form needs to be submitted by a hospital when it is requesting the initiation of an interim rate request. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
Statistical and reimbursement reports fax sheetpdf file
Modified: 9/27/2018
Use this dynamic PDF form to enter data online and e-mail it directly to PARD. You can also fax this statistical and reimbursement report.
Interim rate request form - critical access hospital-swing bed unitpdf file
Modified: 9/26/2018
This form is used by CAH and swing bed providers when requesting the initiation of an interim rate request. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
Interim rate request form - GME onlypdf file
Modified: 9/25/2018
This form needs to be submitted when requesting the initiation of an interim rate request for direct graduate medical education cost information. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
PIP interim rate request form - GME onlypdf file
Modified: 9/25/2018
This form needs to be submitted when requesting the initiation of a periodic interim payment (PIP) request for direct graduate medical education cost information. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
Interim rate request form for a rural health clinicpdf file
Modified: 9/14/2018
This form is used by a rural health clinic when it is requesting the initiation of an interim rate request. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
PIP interim payment request form for a hospitalpdf file
Modified: 9/11/2018
This form is used by a hospital when it is requesting the initiation of a periodic interim payment (PIP) request. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
Interim rate request form - IRF PPS providerspdf file
Modified: 9/10/2018
This form is used by IRF PPS providers when requesting the initiation of an interim rate request. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
PIP interim rate request form - IPF PPS providerspdf file
Modified: 9/10/2018
This form is used by IPF PPS providers when requesting initiation of a periodic interim payment (PIP) request. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
PIP interim rate request form - IRF PPS providerspdf file
Modified: 9/10/2018
This form is used by IRF PPS providers when requesting initiation of a periodic interim payment (PIP) request. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
PIP interim rate request form - TEFRA providerspdf file
Modified: 9/10/2018
This form is used by TEFRA providers when requesting initiation of a periodic interim payment (PIP) request. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
PIP interim rate request form - critical access hospital-swing bed unitpdf file
Modified: 8/1/2018
This form is used by CAH and swing bed providers when requesting the initiation of a PIP interim rate request. Use this dynamic PDF form to enter data online and e-mail it directly to PARD.
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.