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Medical review

Hot topics
more Learn how to electronically submit your claims, medical records, and other correspondence.
Avoid the wait - submit electronically
Targeted probe and educate
CMS has authorized First Coast to conduct reviews utilizing a targeted probe and educate (TPE) review process. View current and upcoming topics, schedules, documentation checklists, educational articles / resources and round results.
Prior authorization
Learn more about the prior authorization (PA) program, including the implementation of the PA program for certain hospital outpatient department (OPD) services.
Post-payment service-specific review
Medical review of claims helps to ensure that Medicare pays for services that are covered, correctly coded, and medically reasonable and necessary.
Medical documentation and checklists
Medical record documentation is required to record pertinent facts, findings, and observations about an individual’s health history including past and present illnesses, examinations, tests, treatments, and outcomes. Find tips, tools and resources for the documentation of clinical services provided to Medicare patients. Use the checklists to ensure you have met medical documentation requirements based on specific services.
Medical Review contacts
Medical Review related questions may be sent to the Medical Review mailboxes. For general information, please call the contact center to speak to a customer service representative or complete a general inquiry request form. Do not include any protected health information (PHI) or personally identifiable information (PII) in the online forms or emails.
Comprehensive Error Rate Testing (CERT)
Contact the First Coast Service Options CERT team at Use this mailbox for general CERT questions or to check the status of a CERT review. It is monitored daily during regular business hours. Please be sure to include the CID and contract number or state. Do not include PHI or PII.
Quick clicks
SPOT is a free web-based application hosted through the CMS Identity Management (IDM) system. SPOT saves you valuable time by offering the ability to view medical review-related additional documentation requests (MR ADR), education details, submit a response with supporting documentation, and check MR ADR status. SPOT users can also view eligibility data, submit and view level-one appeals outcomes, check claim status, access remittance details, and more.
With today's transition to automation, it is even more important to ensure that your physical and mailing address information are kept current with your Medicare administrative contractor.
How satisfied are you with the Medical Review process?
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.
Part A