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.]
Last Modified: 9/15/2022 Location: FL, PR, USVI Business: Part A

Documents required for SNF applications

Effective December 3, 2021, when a SNF submits a CHOW or COI they must include the following documentation with the application:
Legal documentation of CHOW
The legal documents that governed the transaction, such as a sales agreement, bill of sale, or transfer agreement
Form CMS-1561 external pdf file (Health Insurance Benefit Agreement)
Evidence of state licensure, if applicable
Evidence of successful electronic submission of the form HHS-690 external pdf file through the Office of Civil Rights (OCR) portal, as applicable
Evidence should either be written or electronic documentation
Signed patient transfer agreement
Be sure you include all necessary documentation to prevent processing impacts to your application.
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.