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 Medicare.gov 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: 10/2/2022 Location: FL, PR, USVI Business: Part A, Part B

Instructions for completing the EDI SPOT enrollment form for provider organizations

Providers should complete the SPOT Enrollment Form for New Providers to enroll for access to the SPOT portal or to make changes to their existing SPOT setup.

General Information

It is important that you use the most recent version of any EDI form when enrolling for EDI services or updating your existing EDI status. Please carefully review the following block-by-block instructions to ensure successful completion. Note: The following screenshots are for instructional purposes only and cannot be completed and submitted for enrollment.
The SPOT Enrollment Form for Provider Organizations can be completed online and emailed - or printed - before submitting.
The form must be completed and approved before attempting to register for an IDM User ID.

Line of Business/State

Line of Business/State
Instructions
Select one from each drop-down depending on your location and the line of business you submit claims for.

Billing Provider Information

Billing Provider Information
Instructions
Type the (group) provider name.
Type the contact person’s name who has knowledge and authority to answer questions regarding your enrollment.
Type the contact person’s telephone number (including area code) and extension (if applicable).
Type the fax number (including area code) for the provider. This fax number will be used to send your enrollment processing response.
Type the practice mailing address, including suite/building numbers/levels.
Type the (group) Provider Transaction Access Number (PTAN) of the provider.
If you are billing under a group PTAN, only one enrollment form should be completed using the group PTAN. The PTAN, NPI and TIN/EIN are required and must match the number on file with Medicare.
Type the (group) NPI of the provider. The number reported MUST match the number on file with Medicare for the provider and MUST be linked to the PTAN provider on the form. This should NOT be the NPI for an individual member of the group.
Type the full federal Tax Identification Number (TIN) or Employer Identification Number (EIN) of the provider. The full TIN/EIN is required for all SPOT enrollments.

Approver Information

Approver Information
Information
Approver information is required for all new submitter ID requests. Backup approver information is recommended but not required.
Instructions
Designate the member(s) of your staff who will be the office approver and backup approver. Carefully review the role descriptions below to ensure that roles are designated to the most appropriate staff members.
Type the first name, last name, and email address for your approver and backup approver.
Office Approver
Does not have to be the provider/owner, but should be a staff member who is knowledgeable and has tenure with the organization
Should be a staff member who will be utilizing SPOT regularly, due to login requirements for inactivity
Cannot be a representative of a billing service or clearinghouse
Is responsible for creating the organization in Enterprise Identity Management (IDM)
Is responsible for reviewing all end user access requests
Is responsible for certifying all end user access annually
Office Backup Approver
Does not have to be the provider/owner, but should be a staff member who is knowledgeable and has tenure with the organization
Should be a staff member who will be utilizing SPOT regularly, due to login requirements for inactivity
Cannot be a representative of a billing service or clearinghouse
Responsible for reviewing all end user access requests
Responsible for certifying all end user access annually
A backup approver is not required if you do not wish to designate one.
SPOT End User
All other staff members are SPOT end users.

Reason for Request

Reason for Request
Information
The reason for submission is not required.
The options available in the drop-down are “new enrollment” or “change enrollment.”
Instructions
Select the most appropriate option from the drop-down box.

Type of Request

Type of Request
Information
This block is required.
If nothing is selected, a new SPOT submitter ID will be assigned.
Complete only one section: New submitter ID requests or Existing submitter ID requests.
A submitter ID is an EDI-specific ID that drives access to SPOT. A submitter ID is required, even if you are not submitting claims or retrieving electronic claim files through SPOT.
All customers must obtain a new, or link to an existing SPOT submitter ID, to access SPOT – even if you will not be using it to submit your claims.
No changes will be made to your non-SPOT EDI setup with this form.
Instructions for new submitter ID requests
Check the box to assign this provider a new SPOT portal submitter ID.
Disregard the billing software vendor field. This is not needed.
Optional: Check the box to enroll for 276/277 claim status responses
SPOT includes an additional claim status feature that allows all users to view claim status on a claim-by-claim basis. This box is to request the ability to send and receive the ANSI X12N 276/277 transaction files through the claims submission/ERA feature in SPOT.
Verify that your software vendor supports the 276/277 files before requesting this feature.
Instructions for existing submitter ID requests
To link or add 837 to an existing SPOT submitter ID, check the first box to add this provider to an existing SPOT submitter ID and type the existing SPOT submitter ID number and organization name.
This option should be used if your organization already has a SPOT submitter ID assigned, or you are linking to a billing service or clearinghouse’s SPOT submitter ID. Your SPOT submitter ID and SPOT submitter name can be found in your initial SPOT enrollment confirmation letter or under Manage My Roles in IDM.
The submitter ID and name provided must be valid and in the same jurisdiction/contract as the provider.

Electronic Remittance Advice (ERA)

 Electronic Remittance Advice (ERA)
Information
This block is required. ERA is a requirement for enrollment in SPOT.
If nothing is selected, existing ERA setup will be maintained for any provider already set up for ERA. If you do not currently receive ERA, it will be set up to go to the SPOT submitter ID being requested.
This block pertains to the ANSI X12N 835 ERA electronic transaction file. This file can only be sent to one submitter ID.
SPOT includes an additional remittance feature that allows all users to view a readable version of the remittance information like a standard paper remittance (SPR).
Instructions
Click the box to assign ERA to the new submitter ID being requested if you would like to receive the ANSI X12N 835 file through the claim submission/ERA feature in SPOT.
Click the second box to assign ERA to an existing submitter/receiver ID and type the existing SPOT submitter ID where you would like your 835 files to be sent.
Click the third box to maintain existing ERA setup in order to keep your current ERA setup. If a non-SPOT billing service or clearinghouse currently downloads your ERA and you want to keep that setup, choose this option.

Maintain Existing Submitter/Receiver ID

 Maintain Existing Submitter/Receiver ID
Information
This block is required for existing customers.
This block may be skipped for any new SPOT requests.
If you are a new SPOT customer, or do not wish to maintain any existing SPOT submitter/receiver IDs, this block is not required and may be left blank.
Instructions
Type the submitter/receiver’s name(s) or ID number(s) of any existing SPOT submitter/receiver ID(s) currently set up that should remain set up.
All non-SPOT portal submitter IDs will be maintained automatically.
All other SPOT submitter/receiver IDs will be removed immediately if not provided in this block.

PC-ACE

 PC-ACE
Information
PC-ACE is a free software that can be used to create electronic claim files for submission, and to interpret electronic claim reports.
If a third-party billing service or clearinghouse is submitting the claims, it is not necessary for you to select the PC-ACE option unless you will also be submitting claims or needs the software to interpret reports.
Instructions
Read the software terms carefully.
Select “Yes” from the drop-down box to request or maintain the PC-ACE software.

Additional NPI/PTAN Associations

 Additional NPI/PTAN Associations
Information
This section is optional and allows you to add any additional NPI/PTAN combinations you want associated with the TIN listed on page one of the form. An example would be to include the NPI/PTAN of a rendering physician for the NPI provided on page one of the form, which SPOT can use to return a comparative billing report (CBR) specific to that physician and their specialty.
Instructions
Enter department or provider name
Enter PTAN and NPI

Additional Information

 Additional Information
Information
This block is not required.
Your selection in this block is informational only and is not used for your SPOT/EDI setup.
The options available in the Additional Information drop-down box include TIN or NPI.
Instructions
Skip or select the most appropriate option from the dropdown box.

Signature Requirements

 Signature Requirements
Information
This is a required block. The form will be returned if any of these fields are not completed accurately.
The provider’s authorized or delegated official that was listed on the CMS-855 should complete this section with their printed name and title, then sign and date the form. If you are unsure who your authorized or delegated official(s) on file are, this information can be verified in PECOS. external link This information is in the “Managing Control” section. More information about PECOS can be found on the CMS PECOS information website. external link
Instructions
Read the full agreement, attestation, and authorized official signature requirement.
Review the entire form to verify the information provided is accurate and complete.
Type the date the form was signed. The date must be a full month, day, and year.
Type the printed name of the person signing the form.
Type the professional title of the person signing the form.
Print the form.
Sign in the written signature block with a black or blue ink pen.
Email the form to MedicareEDI@FCSO.com or fax to 904-361-0474.
Allow 10 business days for processing.
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.