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Last Modified: 11/23/2021 Location: FL, PR, USVI Business: Part A

Electronic submission of supporting documentation

First Coast encourages all providers to submit cost reports and supporting documentation electronically whenever possible. In addition to the environmental benefits of this approach, it is also more efficient from a time and cost perspective.
We now offer the choice of filing your cost report via the MCReF (Medicare Cost Report e-Filing) portal. The new MCReF portal is a streamlined feature that allows your facility to submit your cost report same day electronically without the cost of sending any hard copy documents! The MCReF system is a secure site that allows for a safe and instant submission of protected health information (PHI). MCReF also notifies you instantly of any submission issues and also stores all your files, resulting in less rejection issues. Sign up today and save time and money!
Information on registering and filing can be found on the MCReF homepage at: external link
For the latest updates regarding MCReF as well as IDM registration information, the MCReF User Manual and FAQS please visit:
Here you can also register for any upcoming training webinars as well.
While using MCReF, please refer issues or questions to:
Phone: 866-484-8049, 866-523-4759 TTY/TDD
Note: When using MCReF to e-file your submission you can also now elect to sign electronically, saving time! (*See Below)
Another benefit of the MCReF portal is that it is a safe and secure site that does not require encryption of protected health information (PHI). Please ensure that any PHI submitted through MCReF is not encrypted or password protected to avoid resulting in a rejection of your submission.
The following documents should be included in your cost report submission either with your MCReF submission or in electronic format (e.g., CD-ROM, flash drive, floppy disk, etc.) when mailing your cost report in manually.
The electronic cost report (ECR) and print image (PI) files utilizing CMS-approved vendor with current specification date. The ECR must pass all level I edits (Exception: If utilizing CMS free software, you must submit a completed hardcopy of the cost report in lieu of the PI file).
If you are claiming costs for interns and residents (IRIS), the IRIS data files that pass all IRIS edits in the CMS IRIS software.
Working trial balance and crosswalk.
Signed audited financial statements.
If you claim Medicare bad debts your submitted listings must match the amount claimed on the cost report. Fee-based bad debts should not be included in this listing.
Wage index documentation (acute care hospitals only).
Documentation for any reclassifications, adjustments, related organizations, contracted therapists, and protested items.
Protected health information (PHI) or personally identifiable information (PII) sent on electronic media (e.g., CD-ROM, flash drive, floppy disk, etc.) must be password protected or encrypted to avoid unintended access via CMS-approved software, e.g., SecureZip. For security purposes, the password must be sent separately via email or fax.
Note: Protected health information (PHI) uploaded via MCReF (Medicare Cost Report e-Filing) portal cannot be encrypted or password protected and will result in a rejection of your submission. The MCReF portal is a safe secure cost report submission option and does not require encryption.
The certification page (worksheet S with encryption coding) of the ECR file with original signature of an officer or administrator must be submitted in hard copy format (paper), unless opting for electronic signature (*See below).
*Please note that the originally signed Worksheet S certification page must be submitted in hardcopy format per CMS regulations or for cost reporting periods ending on or after December 31, 2017, a provider that is required to file an electronic cost report may elect to electronically submit the settlement summary and certification statement with an electronic signature of the provider's administrator or chief financial officer. The checkbox for electronic signature and submission immediately follows the certification statement and must be checked if electronic signature and submission is elected.
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.