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Last Modified: 6/29/2018 Location: FL, PR, USVI Business: Part A, Part B

Secure Messaging FAQ

Q: What types of forms and requests can be submitted through the SPOT’s Secure Messaging? May I submit support documentation with the selected form? What are the submission requirements?
A: The secure messaging feature allows users to select and submit appeal requests, overpayment forms, and additional documentation responses (ADR) from SPOT to First Coast’s e-documentation system. In addition, it also allows users to include support documentation as needed or required.
Secure messaging forms submitted after 6 p.m. ET during weekdays, at any time during a weekend, or on First Coast Service Options’ 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 pdf file
The following forms are available for electronic submission through SPOT:

Secure messaging -- Part A forms:

• Additional documentation response - Respond to ADR requests for prepay claims
• Claim redetermination request - Level 1 appeal request
• Claim reopening request - Clerical reopening
• Electronic Data Interchange enrollment form
• Feedback on the SPOT - Questions and suggestions about SPOT
• General inquiry request - Questions about Medicare program/policies

Secure messaging – Part B forms:

• Additional documentation response - Respond to ADR requests for prepay claim
• Claim redetermination request - Level 1 appeal request
• Claim reopening request - Clerical reopening
• Electronic Data Interchange enrollment form
• 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

How to access a secure messaging form

1. Select ‘Request’ from the secure messaging submenu
2. The ‘Submit Form: Selection form’ will appear. Selections will differ based upon the line of business of the profile selected.
Image of Select secure messaging form 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.

Submission guidelines: ADR 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 Service Options as well as any requested documentation in your submission. All documents must be submitted in PDF format (8MB 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

Submission guidelines: Claim redetermination request (Part A/Part B)

• The claim redetermination request form is to be used to file first-level appeals.
• You must file the claim redetermination request within 120 days of the initial claim determination
• This form may not be used for a claim adjustment
• You must upload documentation to support your claim. All documents must be submitted in PDF format (6MB maximum)
• The processing of your request will be based solely on the information included in your submission
• Submissions on weekends, holidays or after 6 PM ET weekdays will receive a receipt date that reflects the next business day.

Submission guidelines: Claim reopening request (Part A)

• This form is to be used for clerical reopenings only
• This form may not be used for a claim adjustment or for an adjusted claim
• You must include the CMS-1450 (UB-04) with your submission
• You must upload documentation to support your claim. All documents must be submitted in PDF format (6MB 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.

Submission guidelines: MSP overpayment refund form (Part B)

• 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 (6MB 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.

Submission guidelines: Non-MSP overpayment refund form (Part B)

• 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 (6MB maximum)
• The processing of your request will be based solely on the information included in your submission
• Submissions on weekends, holidays or after 6 PM ET weekdays will receive a receipt date that reflects the next business day.

Submission guidelines: Overpayment redetermination request (Part B)

• 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 (6MB 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.

Submission guidelines: General inquiry request form (Part A/Part B)

• The purpose of this form is to submit questions regarding the Medical program
• Support documentation is optional.
• All documents must be submitted in PDF format (6MB 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.

Submission guidelines: SPOT feedback form (Part A/Part B)

• 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.
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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.