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Last Modified: 3/1/2018 Location: FL, PR, USVI Business: Part A

Electronic submission of supporting documentation

First Coast Service Options Inc. (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.
The following documents should be sent in an electronic format (e.g., CD-ROM, flash drive, floppy disk, etc).
The electronic cost report (ECR) and print image (PI) files utilizing Centers for Medicare & Medicaid Services (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).
Provider cost report reimbursement questionnaire, Form CMS-339 which is now part of the 2552-10, 2540-10, and 265-11 cost reporting forms.
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 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.
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). First Coast offers the option of filing your cost report via the SPOT portal. Information on registering and filing can be found on the SPOT homepage. Please note that the originally signed Worksheet S certification page must be submitted in hardcopy format per CMS regulations.
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.