For clearinghouses, billing services, network service vendors and third-party vendors considering submitting claims via Electronic Data Interchange (EDI), the following information outlines procedures related to getting started.

1. Choose the method of claim file creation: Determine how your office will create the 837 electronic claim file. If your office already has a method of creating claim files, contact your current vendor first to discuss billing Medicare electronic claims to First Coast.
   
   1. PC-ACE - this software is used for claim creation and report interpretation. It is available as a free download to all EDI customers through First Coast. Please visit "Getting started with PC-ACE" for the technical requirements and additional information about this product.
      

   2. Vendor - many other software programs are available for creating electronic claim files. Refer to "Choosing a vendor" for instructions on vendor selection. Specific services and financial arrangements must be made between your office and the vendor.
      

2. Choose the method of submission: Determine the method you will use to submit the electronic claim files.
   1. Secure Provider Online Tool (SPOT) – a free, web-based application hosted through the secure CMS Identity Management System. First Coast provides direct help desk support and many online resources for SPOT.
   2. Secure File Transfer Protocol (SFTP) - contract with a Network Service Vendor (NSV) for direct connectivity to the First Coast EDI Gateway. For a list of established NSVs, refer to the to the approved vendor list. Specific services and financial arrangements must be made between the provider and the NSV.
   3. Clearinghouse – third party entities that are available to submit electronic claim files. Some of these entities also offer claim file creation. Refer to the approved vendor list for a list of clearinghouses currently enrolled and approved with First Coast. Specific services and financial arrangements must be made between the provider and the clearinghouse.
   4. Hypertext Transfer Protocol Secure (HTTPS) Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules (CORE)-Compliant Connection – this technical method of submission required the purchase of a digital certificate from a trusted certificate authority. For details on this method, refer to the First Coast HTTPS CAQH CORE complaint connectivity guide.
3. Complete the proper form: Once you decide the method of submission, you will need to complete the following form:
   
   1. EDI SPOT Enrollment Form for third-party organizations-  This form is an agreement mandated by the CMS to be completed by each billing service or clearinghouse requesting access to the SPOT online portal. This form is required for the initial SPOT setup with First Coast. Once this form is processed, the office approver will need to complete the registration process in the identity management (IDM) system. Follow the detailed completion instructions  carefully. This form is only for billing services or clearinghouses. Providers needing access to SPOT should complete the EDI SPOT Enrollment form for provider offices.
   2. EDI third party enrollment form - This form is an agreement mandated by the CMS to be completed by each billing service, clearinghouse, or vendor. This form will allow you to receive a sender/submitter number, mailbox ID and a password, which allows you to access different applications. Complete this form if your office will perform the electronic billing. Follow the detailed completion instructions carefully. This form is only for clearinghouses, billing services, network service vendors and third party vendors . Providers should complete the EDI enrollment form.
      

4. Submit test claims: If you have not selected a previously approved vendor to create claim files, you will be required to submit a batch of test claims (from your office to our office not the vendor location), for evaluation. The Medicare EDI testing area will evaluate the test and contact you with the results. The test must meet accuracy requirements to be approved to submit production electronic claims for processing.
   
   This step cannot be completed until you have been assigned an EDI sender/submitter number. Test claims do not need to be new claims. If you are unable to collect enough new claims for a test, you may use claims that have already been processed. Your test is submitted into a separate testing system and is not processed for payment.
   
   You should receive the test results within three working days from the date the test data is received by First Coast EDI.
   

5. Submit production claims: Upon approval to submit production claims (passed the test, if required), you may begin submitting claims electronically in the production environment for any providers setup to have claims sent to First Coast through your company. Claims will need submitted within 30 days to establish the required connection. We request that you transmit at least one production batch per month to keep your sender number and password active.
   

6. Retrieve reports: These reports after each 837 claim file submission to ensure the claims are accepted.
   
   1. Initial Acknowledgement (999)
      

   2. Electronic receipt of claim submission (Health Care Claim Acknowledgement) (277CA)
      

   3. Electronic remittance advice (ERA) (835)
      1. Part A - PC-Print is available from First Coast to view and print Part A 835 files.
      2. Part B - Medicare Remit Easy Print (MREP) is available from First Coast to view and print Part B 835 files.
         

   4. Electronic claim status (ECS) (276 / 277)
      

If you have any questions concerning these steps or other electronic applications, contact Medicare EDI at 888-670-0940.