J9 First Coast: Puerto Rico Medicare
First Coast Service Options Inc. (First Coast) administers Medicare health insurance for the Centers for Medicare & Medicaid Services (CMS) for Jurisdiction 9 which includes the State of Florida and Puerto Rico. If you are a provider located in the State of Florida or Puerto Rico and need to become an electronic submitter for your Medicare A/B Claims, please follow the enrollment instructions below.
Required Documents for those applying for new Submitter ID's.
The following document is a required enrollment document that must be completed, signed and returned to the First Coast office prior to initiation of electronic claims submission or inquiry.
1. EDI Enrollment Form with Instructions
If the above link does not work properly, please copy the link below into a new tab or browser, and select your state and line of business:
If you have any questions regarding this process, please call First Coast EDI Technology Support Center at 1-888-670-0940, option 4.
We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.
EDI Enrollment Form
Select your line of business and state
Type the submitter name. If new request type the intended name of submitter.
If you are an existing submitter, indicate the submitter number, if not leave blank.
Type the name of the group, physician, provider, or supplier enrolling for electronic data interchange (EDI).
The name listed must match the name on file at Medicare for the NPI/PTAN listed in Block D.
Type the practice address, including suite/building numbers/levels, of the group, physician, provider, or supplier enrolling for EDI.
The address must match the address on file at Medicare for the NPI/PTAN listed in Block D.
Type the contact person's name who has the knowledge and authority to answer questions regarding your enrollment
Type the telephone number (including area code) of the contact person listed and their extension
Type the FAX number (including area code) of the group, physician or supplier.
Type the email address of the contact person. An email may be sent when the form is processed.
Type the TAX ID or SS number of group, physician, provider, or supplier enrolling for EDI.
Type the NPI of the group, physician, provider, or supplier enrolling in EDI.
The Medicare PTAN is optional. If you are requesting approval for multiple NPI/PTAN, a separate EDI form must be completed for each provider number/practice. If you are billing under a group NPI, only one EDI form should be completed using the group NPI. The number reported must match the number on file at Medicare for the group, physician, provider, or supplier name listed in Block B.
Do not check the box for PC-Ace Pro 32
For name of Software Vendor , enter the name of the software or vendor that creates your 837 files. If you have purchased our SolAce software, call us for our Vendor information.
If you are applying to become a direct submitter enter your name and check the box for Provider
If you are a billing service submitting claims on behalf of a provider, enter your business name and check the box for billing service.
Check the box to "Assign this provider a new electronic billing submitter ID"
If you are a new submitter skip this section
If you have an existing Submitter ID you wish to be linked to this new submitter ID, check the box and enter the number
Check the box for "new submitter ID being requested in block F"
Skip this section
Type or print the name and title of the authorized provider signature. Third-party billers are not authorized to sign any part of the EDI enrollment. Print document then sign in Authorized Signature box. Write in date after document has been printed and signed.
Submitting your Form
It is recommended that you keep a copy of all the forms you will be submitting for your records. When the form is complete, print, sign, and date it, and either fax or mail to Medicare EDI.
FCSO Medicare EDI
P.O. Box 44071 - 3C
Jacksonville, FL 32231-4071
It is very important that you complete and fax the entire enrollment packet as described above. Incomplete packets will not be processed, and will be returned to the submitter.
Waiting for a Response
Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)
After processing, a confirmation will be mailed to you as notification to begin filing claims electronically. If a returned letter is not received after two weeks, contact the Technology Support Center at 1-888-670-0940, Option 4.
Once you have received your Submitter ID and Password for First Coast, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission.
Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment, but will be validated against production files, therefore, they must contain valid patient procedure, diagnosis, and provider information.