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SPOT claim submission agreement

With the upcoming SPOT redesign, organizations will have the ability to submit electronic claims through SPOT.
Only organizations wishing to opt into electronic claim submission through SPOT are required to submit this form. Access to this upcoming feature is optional. No action is needed for organizations that do not wish to access SPOT’s claim submission feature.
Electronic Remittance Advice (ERA), in the ANSI 5010 format, will also become available with the redesign. To have ERA moved to your SPOT submitter/receiver ID, you will need to complete the SPOT Enrollment Form after the redesigned portal is available.
Note: This form is exclusively for existing SPOT approvers wishing to opt-in to claim submission via SPOT.
By submitting this form, as the designated SPOT account approver for the organization listed below, the provider confirms they have read and agree with the provider EDI agreement and the CMS' obligations as identified in the following terms and conditions.
Once submitted, your request will be reviewed by the SPOT help desk. You will be contacted via email once your account has been updated for claim submission.
Please fill out the form below:
* Provide your organization’s submitter ID received with your portal access approval. Do not enter your User ID, NPI, or PTAN in the submitter ID field. If you do not know your submitter ID, refer to the Manage My Roles tile within IDM or your approval letter. All providers linked to this SPOT submitter ID will be setup with the ability to submit claims.
*Only submit one form for each SPOT submitter ID. Please do not submit duplicate forms. If your organization has more than one SPOT submitter ID, a form will be required for each submitter ID.
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.