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First Coast Service Options Inc. (First Coast) administers Medicare health insurance for the Centers for Medicare & Medicaid Services (CMS) for Jurisdiction N which includes the State of Florida. If you are a provider located in the State of Florida 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:

http://medicare.fcso.com/EDI_Forms/

If you have any questions regarding this process, please call First Coast EDI Technology Support Center at 1-888-670-0940.

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.

Our Vendor Information

EDI Enrollment Form

General Information

• Select your line of business and state

Provider Information

• Please enter your Provider or DBA name

• Please fill in your contact and demographic information

  • This must match what Medicare has on file

• Next, please enter your PTAN, NPI, and Tax ID

Reason for Request

• Please select "New Enrollment" from the drop-down

Type of Request

• Please check the first box "Assign this provider a new electronic Submitter ID"

• For name of Network Service Vendor and Software Vendor please enter "Axiom Systems Inc"

Electronic Remittance Advice

• If you would like electronic remittance advice check the box "Assign ERA to the new submitter ID being requested with this form"

Maintain Existing Submitter ID

• If you are a new submitter please leave this section blank

PC Ace Enrollment

• Please leave this section blank

Preference for Aggregation

• Check off either tax ID or NPI

Signature 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, email, or mail to Medicare EDI. We recommend faxing or emailing for expedited processing.

Mailing address
FCSO Medicare EDI
P.O. Box 44071
Jacksonville, FL 32231-4071

Fax: 904-361-0470

Email: MedicareEDI@fcso.com

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.

Testing

Once you have received your Submitter ID and Password for First Coast, please call the SolAce 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.