The “payment floor” is a waiting period during which time the contractor may not pay, issue, mail, or otherwise finalize the initial determination on a clean claim. There are different waiting periods for electronic claims and paper claims. The waiting periods are 13 days for electronic claims and 28 days for paper claims. However, the payment may not be issued until day 14 (electronic) or 29 (paper).

TPE reduces provider burden, claim denials, and appeals through one-on-one education.

If your provider type, supplier type, physician specialty, or non-physician specialty type is not listed in the application, please select other, undefined physician specialty, or undefined non-physician practitioner specialty. Then list your type or specialty in the provided field.

For providers that enroll solely to order or refer services using the CMS-855O, it is a national enrollment. When you relocate to another state, you are not required to dis-enroll from the current state and re-enroll in the new state. The contractor that maintains your CMS-855O enrollment in PECOS is responsible for processing change of information applications including relocating to a state outside of their jurisdiction and updating the current enrollment with any new licenses obtained in the new state.

Reference: 

Refer to: Requesting SPOT end user role

Yes, for initial, revalidation and reactivation applications, a Puerto Rico and/or U.S. Virgin Islands provider is required to submit a letter of good standing with his or her application if there is no online verification source to verify a medical license. The letter of good standing is not required with a change of information application unless it involves a license update/change. 

Refer to: How to register for SPOT

You can call the JN provider enrollment help desk at 1-888-845-8614 to request a copy of the letter, as long as you're currently listed on the enrollment record. You can also submit a request for a copy of your enrollment certification by sending a request for the information on company letterhead to First Coast’s provider enrollment department. The request needs to be signed by either the authorized official (AO), delegated official (DO) or the practitioner as it is listed on your entity’s enrollment record.

The effective date is the later of the following two dates:

• The filing date of an enrollment application that was subsequently approved, or
• The date the provider first began furnishing services at a new practice location.

The provider may bill retrospectively for services when: