Last Modified: 10/21/2021
Location: FL, PR, USVI
Business: Part A, Part B
Q: What types of requests and forms can be submitted, requested, and retrieved through SPOT’s Secure Documentation? What are the submission requirements?
A: The secure documentation feature allows users to request and retrieve a variety of documents from First Coast as well as submit secure documentation to First Coast’s e-documentation system. Secure documentation forms submitted after 6 p.m. ET during weekdays, at any time during a weekend, or on First Coast’s corporate holidays will receive a receipt date that reflects First Coast’s next business day.
Please allow 48-72 hours before checking the status of your request. For more information, please refer to
The SPOT User Guide 
To request documentation, select “Request Documentation” from the “Secure Documentation” menu.
From the drop-down menu, select one of the following and follow the form instructions:
• Demand letters
• 1099 Form
• CBR (Comparative Billing Report)
• PDS (Provider Data Summary)
The following forms are available for electronic submission through SPOT:
• Additional development response - Respond to ADR requests for prepay claims
• ADR response for medical review
• Provider Audit & Reimbursement
• Credit Balance Report
• Prior Authorization Request Form
• Feedback on the SPOT - Questions and suggestions about SPOT
• General inquiry request - Questions about Medicare program/policies
• Additional development response - Respond to ADR requests for prepay claim
• ADR response for medical review
• Feedback on the SPOT - Questions and suggestions about SPOT
• General inquiry request - Questions about Medicare program/policies
• MSP overpayment form - Voluntary refund of an overpayment for an MSP claim
• Non-MSP overpayment form - Voluntary refund of an overpayment for a non-MSP claim
• Overpayment redetermination request - Appeal of an overpayment decision
• Prior Authorization Request Form
1. Select ‘Submit documentation’ from the Secure Documentation submenu
2. The ‘Submit Secure Documentation’ form will appear. Selections will differ based upon the line of business of the profile selected. The image below is a Part B menu.
3. Select the form you need from the list. Required fields will be marked with a red *, and directions will be listed at the top of the page of each form.
• The additional documentation response (ADR) form should be used to respond to claim ADR requests for prepay (i.e., non-finalized) claims.
• You must include a copy of the ADR request letter you received from the First Coast as well as any requested documentation in your submission. All documents must be submitted in PDF format (15 MB maximum)
• Only one submission per ADR request letter will be accepted, and the processing of your claim will be based upon the information in your submission.
Note: If the receipt date of your response is not within the timeliness guidelines of the date listed in the ADR letter, or if you did not include a copy of the ADR letter and/or any of the requested documentation in your submission, your service or claim may be denied.
• Submissions on weekends, holidays or after 6 p.m. ET weekdays will receive a receipt date that reflects the next business day.
• The Part A and Part B versions of the ADR form are identical, with the exception of the ICN/DCN fields
• The SPOT’s ADR form should not be used to respond to any of the following:
• Documentation requests from other operational areas (e.g., EDI, provider enrollment)
• Post-payment medical review documentation requests
• Pre-payment/post-payment ADR requests for non-First Coast claims
• PWK submissions
• Appeal ADR requests
• ADR requests from the ZPIC
• ADR requests from the RAC
• ADR requests from the SMRC
• The additional development response (ADR) for MR should be used to respond to documentation requests from First Coast’s Medical Review department.
• You must include a copy of the MR ADR request letter you received from First Coast’s Medical Review department as well as any requested documentation in your submission. All documents must be submitted in PDF format (15 MB maximum)
• Only one submission per ADR request letter will be accepted, and the processing of your claim will be based upon the information in your submission.
Note: If the receipt date of your response is not within the timeliness guidelines of the date listed in the ADR letter, or if you did not include a copy of the ADR letter and/or any of the requested documentation in your submission, your service or claim may be denied.
• Submissions on weekends, holidays or after 6 p.m. ET weekdays will receive a receipt date that reflects the next business day.
• The Part A and Part B versions of the ADR form are identical, with the exception of the ICN/DCN fields
• The SPOT’s ADRs for Medical Review-related claims form should not be used to respond to any of the following:
• Non-medical review-related ADR requests
• Documentation requests from other operational areas (e.g., EDI, provider enrollment)
• Pre-payment/post-payment ADR requests for non-First Coast claims
• PWK submissions
• Appeal ADR requests
• ADR requests from the ZPIC
• ADR requests from the RAC
• ADR requests from the SMRC
• This form is for a voluntary refund of an overpayment for a Medicare secondary payer (MSP) claim
• If specific patient and claim data are not available for all related claims due to statistical sampling, please indicate methodology and formula used to determine amount and the reason for overpayment in support documentation.
• All documents must be submitted in PDF format (8 MB maximum)
• The processing of your request will be based solely on the information included in your submission
• Submissions on weekends, holidays or after 6 p.m. ET weekdays will receive a receipt date that reflects the next business day.
• This form is for a voluntary refund of an overpayment for a Non-MSP claim
• If specific patient and claim data are not available for all related claims due to statistical sampling, please indicate methodology and formula used to determine amount and the reason for overpayment in support documentation.
• All documents must be submitted in PDF format (8 MB maximum)
• The processing of your request will be based solely on the information included in your submission
• Submissions on weekends, holidays or after 6 p.m. ET weekdays will receive a receipt date that reflects the next business day.
• This form is to appeal an overpayment decision
• You must upload a copy of your demand letter as part of your submission.
• If multiple ICNs are affected by this request, please upload a complete list and associated claim information. All documents must be submitted in PDF format (8 MB maximum)
• The processing of your request will be based solely on the information included in your submission
• Submissions on weekends, holidays or after 6 p.m. ET weekdays will receive a receipt date that reflects the next business day.
• The purpose of this form is to submit questions regarding the Medicare program
• Support documentation is optional.
• All documents must be submitted in PDF format (8 MB maximum)
• The processing of your request will be based solely on the information included in your submission
• Submissions on weekends, holidays or after 6 p.m. ET weekdays will receive a receipt date that reflects the next business day.
• The purpose of this form is to submit questions or comments regarding the SPOT
• The processing of your request will be based solely on the information included in your submission
• Submissions on weekends, holidays or after 6 p.m. ET weekdays will receive a receipt date that reflects the next business day.
• The purpose of this form is for Part A providers to submit their credit balance report (CMS-838)
• Users must click the link provided on the form to access the CMS-838 form and complete it
• The form must be submitted in PDF format (10 MB maximum)
• Submissions on weekends, holidays or after 6 p.m. ET weekdays will receive a receipt date that reflects the next business day.
• The purpose of this form is for Part A and B providers to submit a request for prior authorization for certain hospital outpatient department services
• Users must complete and upload the appropriate PAR coversheet prior to submitting additional documentation
• The documents must be submitted in PDF format (50 MB maximum)
• Submissions on weekends, holidays or after 6 p.m. ET weekdays will receive a receipt date that reflects the next business day.
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.
