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Form 480.6A -- "Informativa de Ingreso"

First Coast, as a MAC, is only responsible for withholding monies and/or taxes established by the United States federal government.

Form 480.6A -- "Informativa de Ingreso"

First Coast, as a MAC, is only responsible for withholding monies and/or taxes established by the United States federal government.

First Coast IRS forms 1099-MISC and 1099C

Providers who require a copy of IRS form 1099-MISC may send a request, in writing, to First Coast.

Tools & forms: Claims

Use these self-service tools and forms related to claims.

Provider audit master information form

This form is used by Medicare Part A providers who change the default or other contact who receives their interim rate, tentative settlement, NPR & NOC-PR determinations.

First Coast IRS forms 1099-MISC and 1099C

Providers who require a copy of IRS form 1099-MISC may send a request, in writing, to First Coast.

CMS-1500 (02/12) paper claim form

Find information on where to obtain and how to complete the CMS-1500 claim form.

Tools & forms: Claims

Use these self-service tools and forms related to claims.

Ambulance

Information for ambulance providers, including links to LCDs/NCDs, education, FAQs, provider enrollment, CMS IOMs, and other resources.

Avoiding hospice claim rejects

Providers billing Medicare should determine if a patient is enrolled in hospice before billing Medicare Part A. This article has tips on checking patient eligibility and avoiding hospice claim…