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Last Modified: 10/30/2017 Location: FL, PR, USVI Business: Part B

Overpayment redetermination requests

To ensure efficient processing of overpayment redetermination requests please complete the appropriate Overpayment redetermination request for a Medicare Part B claim form and mail to the post office box identified on the form.
Florida providers
Click to access the Overpayment redetermination request form for a Medicare Part B claim for Florida pdf file. Mail the completed form with supporting documentation to:
Medicare Part B Overpayment Redetermination
P.O. Box 45248
Jacksonville, FL 32232-5248
Puerto Rico providers
Click to access the Overpayment redetermination request form for a Medicare Part B claim for Puerto Rico pdf file. Mail the completed form with supporting documentation to:
Medicare Part B Overpayment Redetermination
P.O. Box 45015
Jacksonville, FL 32232-5015
U.S. Virgin Islands providers
Click to access the Overpayment redetermination request form for a Medicare Part B claim for the U.S. Virgin Islands pdf file. Mail the completed form with supporting documentation to:
Medicare Part B Overpayment Redetermination
P.O. Box 45091
Jacksonville, FL 32232-5091
Completion of the Overpayment redetermination request for a Medicare Part B claim form and addressing the request to the appropriate mailbox is critical to correct processing of your overpayment redetermination request. Using this form makes handling requests for overpayment redeterminations easier and more efficient for providers’ offices.
Note: Complete the Overpayment redetermination request for a Medicare Part B claim form if you are disputing an existing overpayment. If First Coast Service Options Inc. (First Coast) has not sent a demand letter requesting a refund of payment and you are notifying First Coast of an overpayment, you must complete the overpayment refund form:
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.