Last Modified: 4/3/2018 Location: FL, PR, USVI Business: Part A, Part B
Welcome prospective providers
Welcome to the First Coast Service Options Inc. (First Coast), family of Medicare providers. First Coast has been a Medicare administrator for more than 40 years. We are one of the nation’s largest Medicare administrators, and proudly serve more than three million beneficiaries and the health care providers who care for them.
As a prospective provider to the Medicare program, our goal is to help guide you through your enrollment process. To get you started, we have provided several links below to the critical information and education tools you will need to accurately complete the application process.
Which enrollment form do I choose?
Go here to determine which provider enrollment application you need to submit to enroll in the Medicare Program. Also, access the Provider Enrollment Application Assistance Tool for more help in determining the appropriate enrollment form for submission.
How do I complete a CMS-855 form?
The following links will provide you with tools, tips, and step-by-step directions to completing the myriad of CMS-855 forms to help ensure your application processes successfully the first time.
• Go here for helpful tips on completing all CMS-855 forms
CMS-855A (for institutional providers)
• Go here to view a simulation on how to complete the CMS-855A form
• Go here to complete the interactive CMS-855A form. Once completed, print it and submit it.
CMS-855B (for clinics/group practices and certain other suppliers)
• Go here to view how you can avoid the errors that result in the CMS-855B form not being processed, specifically missing signatures or dates in Section 15B and Section 16A.
• Go here to complete the interactive CMS-855B form. Once completed, print it and submit it.
CMS-855I (for physicians and non-physician practitioners)
• Go here for step-by-step directions to completing the CMS-855I form.
• Go here to view how you can avoid the errors that result in the CMS-855I form not being processed, specifically missing signatures or other required information.
• Go here to complete the interactive CMS-855I form. Once completed, print it and submit it.
CMS-855R (for reassignment of benefits)
• Go here for step-by-step guidance to completing the CMS-855R form
• Go here to see a simulation on how to avoid the No. 1 reason applications are denied
• Go here to complete the interactive CMS-855R form. Once completed, print it and submit it.
Electronic Funds Transfer
• Go here to find out the advantages of Electronic Funds Transfer (EFT), and the most common problem seen with the EFT application.
Note: The Centers for Medicare & Medicaid Services recently approved two new enrollment forms, CMS-855C and CMS-855POH. For more information, access the change request (CR) 9120 and the CMS Forms List page.
The internet-based Provider Enrollment, Chain, and Ownership System (PECOS) facilitates the Medicare provider enrollment process by furnishing health care providers and suppliers with an easier, faster, and more efficient alternative to paper-based enrollment in the Medicare program. Registered users may use the system for initial enrollment as well as to change, reactivate, or voluntarily terminate an existing enrollment record. Users may also add, change, or terminate reassignment of Medicare benefits.
• Go here to find out how to access the internet-based PECOS
Where do I submit my provider enrollment documentation?
Medicare Provider Enrollment
First Coast Service Options Inc.
P.O. Box 44021
Jacksonville, FL 32231-4021
P.O. Box 44021
Jacksonville, FL 32231-4021
Where can I learn more?
Please review our Part A or Part B Provider enrollment FAQs as well as our online education opportunities.
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.