This updated form is for an appeal and is not to be used when requesting a claim adjustment. Fill it out online, then print and mail it to the address indicated on the form.
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This SPOT form is for third-party organizations such as clearinghouses and billing services to request access to SPOT.
This form is used by a billing service or clearinghouse to set up previously enrolled providers for SPOT.
Provider and third-party billing agent organizations should use this form to request updates to their SPOT registration, such as changing an approver.
Minor clerical errors or omissions can be corrected more quickly outside of the formal appeal process. Use this interactive form to help ensure your request is processed accurately.
November 2025 electronic billing newsletter.
February 2026 electronic billing newsletter