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Last Modified: 10/6/2022 Location: FL, PR, USVI Business: Part A

How to use SPOT to submit appeals and check status

SPOT offers providers a convenient way to submit appeal requests – specifically level-one and level-two appeals – also called redeterminations and reconsiderations.
These types of appeals are separate from reopenings, which occur outside of the appeals process, and are how providers correct minor errors or omissions on their claims. (Note: Reopenings can also be done via SPOT; view information here.
Part A: Submit redeterminations and reconsiderations
Part A providers can easily submit redeterminations and reconsiderations via SPOT.
Redeterminations
First, access the claim details by selecting Appeal Requests / Outcome from the Appeals submenu.
Note: for claims processed more than 12 months ago, select Redetermination Request from the Appeals submenu to be directed to the redetermination form.
Use the Claim Status and Appeals Requests query form to conduct a search
Once results appear, choose the claim from the resulting list, and click on the applicable claim number to view the available appeal options
To submit a level-one appeal (redetermination), click on the Submit an Appeal button
Complete the form, upload supporting documentation, and click Submit
Submit an appeal level 1 - claim redetermination form
Reconsiderations
To submit a level-two appeal (reconsideration):
Click on the L2 request link from the claim status page
Level 2 appeal - L2 request link
Complete the fields on the Claim Reconsideration form, load supporting documentation, and click Submit
-Level 2 - reconsideration request form

How to check your appeal outcome

Access the claim details by selecting Appeal Requests / Outcome from the Appeals submenu.
Use the Claim status and appeals requests query form to conduct a search
Note: For appeals submitted on claims processed more than 12 months ago, select Appeals Outcome from the Appeals submenu to be directed to the appeals outcome search.
On the results screen, click on the applicable claim number to view appeals information
Details include appeals status, outcome, and the ability to view decision letters
Level 2 appeal - L2 request link
Part A possible outcomes:
Favorable
Unfavorable
Partially favorable
Pending

Need more guidance?

View the SPOT User Guide pdf file for more details on submitting appeals and all of SPOT’s features and functions.

We’d love to hear from you

Please take a few minutes to let us know about your experience with the redetermination process.
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.