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Last Modified: 10/28/2021 Location: FL, PR, USVI Business: Part B

Electronic submission

Avoid the wait, submit electronically

Appeals forms

Providers, participating physicians, and other suppliers have the right to appeal claim decisions. Appeals must be submitted using the following forms:
more First level: Request for redetermination of a Part B claim
more Second level: Reconsideration request form -- C2C Innovative Solutions Inc.
Florida pdf file
more Third level: Hearing by an administrative law judge
more Fourth level: Medicare Appeals Council

Minor error? Request a claim reopening

Did your claim have a clerical error or other minor discrepancy? Part B claims may be corrected outside of the appeals process.
more Correct your claim online through the SPOT -- SPOT offers registered users the time-saving advantage of not only viewing claim data online but also the option of correcting clerical errors in their eligible Part B claims quickly, easily, and securely -- online.
more Correct your claim using the reopening gateway – The reopening gateway offers a quick and easy way to make Part B claim corrections directly on the First Coast website.
more Correct your claim using the interactive voice response (IVR) -- The IVR allows providers/customers to call in to request reopenings on certain claims
more Correct your claim by writing in, using the first level of appeal (redetermination). Writing in allows you to supply additional information you feel is necessary to correct a claim.

Additional resources

more Understand when to file an appeal and the time limits for filing requests
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.