Tools & forms: EDI / SPOT
Tools
Secure Provider Online Tool
5010 Reject Code Lookup
TIBCO Gateway Password Change
TIBCO Gateway Password Check
ERA Reload Request
HETS EDI Enrollment ToolForms
| Form | Description | Instructions |
|---|---|---|
| This interactive “Electronic Data Interchange (EDI) enrollment form” is intended for provider use only. | ||
| This form is for provider organizations to request access to SPOT with claim transactions submission and designate their approvers. | ||
| This form is for third-party agents such as clearinghouses and billing services to enroll for electronic transactions. | ||
| This SPOT form is for third-party organizations such as clearinghouses and billing services to request access to SPOT. | ||
| This form is to change the address or contact information for an existing EDI Submitter ID. |
N/A |
|
| This form is to change the address or contact information for an existing SPOT Submitter ID. | ||
| This interactive form is intended for trading partner provider use only. Please see the HTTPS CAQH CORE Connection Guide for connectivity requirements. | ||
| This interactive form is intended for third party trading partners such as billing services or clearinghouses. Please see the HTTPS CAQH CORE Connection Guide for connectivity requirements. This form was updated in R1-22. | ||
| This form is to enroll multiple group or solo providers with the EDI enrollment or SPOT enrollment process. Note: Form 8292 or 8292P must be submitted with this form. |
N/A |
|
| This form is to request the conversion of multiple providers who are currently setup for electronic billing to First Coast through your organization to your SPOT submitter ID Note: Form 8292 or 8292P must be submitted with this form. |
N/A |
|
| The Part A (DDE) user ID request form is intended for provider use to DDE enrollment forms. |
N/A |
|
| Use this form for voluntary submission of supporting documentation with a version 5010 electronic claim. This is NOT an EDI enrollment form. |