Submit prior authorization requests electronically
Are you using regular mail for submissions to First Coast? We have several electronic options that are easier and faster for you to use. Additionally, submitting documentation electronically:
- Saves time, electronic submission eliminates mailing delays
- Eliminates administrative costs, electronic submission costs nothing
- Protects patient information, electronic submission is secure
- Allows for the immediate confirmation of receipt, electronic submission provides transaction confirmations
Read on to find out how you can avoid the wait by submitting electronically.
Prior authorization request for certain hospital OPD services
CMS implemented a prior authorization (PA) program for certain hospital OPD services for dates of service on or after July 1, 2020, nationwide. CMS believes prior authorization for certain hospital OPD services will ensure that Medicare beneficiaries continue to receive medically necessary care while protecting the Medicare Trust Fund from improper payments and keeping the medical necessity documentation requirements unchanged for providers.
For details, links, and submission guidelines refer to PA program for certain hospital OPD services.
- Be sure to include the Prior Authorization Request coversheet and supporting medical documentation with your request and follow the instructions for completing the coversheet:
- Do not use the expedited prior authorization request coversheet unless the normal timeframe for a decision notification could jeopardize the life or health of the beneficiary. If the medical records submitted with the expedited request do not justify an expedited request, then the request will be subject to the normal process and timeframes.
- Do not use the expedited prior authorization request coversheet unless the normal timeframe for a decision notification could jeopardize the life or health of the beneficiary. If the medical records submitted with the expedited request do not justify an expedited request, then the request will be subject to the normal process and timeframes.
| Electronic submission method | Submission instructions | Additional resources |
|---|---|---|
| SPOT |
SPOT is a FREE, secure internet portal for Part A and B providers to use to easily connect directly to First Coast. SPOT provides quick access to several time-saving features. To submit a prior authorization request, select the Secure Documentation option from the SPOT toolbar and then select Prior Authorization Requests Form from the drop-down menu. |
To learn more and enroll with SPOT, visit the SPOT website |
| Fax |
The fax to image option allows for documentation to be submitted directly First Coast: Fax number 1-855-815-3065 Faxes should not exceed 200 pages |
For more information, visit PA program for certain hospital OPD services. |
| esMD |
Providers may submit a prior authorization request for certain hospital OPD services electronically through esMD: Indicate document/content type "8.5". |
To sign up for esMD, visit Electronic Submission of Medical Documentation (esMD) on the CMS website. |
Prior authorization request for Part B repetitive scheduled non-emergent ambulance transportation (RSNAT) services
Effective March 18, 2022, states and territories within jurisdiction N (Florida, Puerto Rico, and U.S. Virgin Islands) are now included in the prior authorization for RSNAT services initiative.
By submitting a complete coversheet and the required documentation, a supplier can receive provisional prior authorization for as many as 40 round trips (80 one-way transports) in a 60-day period.
For details, links, and submission guidelines refer to PA program for RSNAT.
- Be sure to include the PA Request for RSNAT Medicare Part B Fax/Mail Coversheet and supporting medical documentation with your request and follow the instructions for completing the coversheet:
- If the normal timeframe jeopardizes the life or health of the beneficiary, an expedited request can be submitted. However, if medical documentation does not support an expedited process, the request will be subject to the normal timeframe.
- If the normal timeframe jeopardizes the life or health of the beneficiary, an expedited request can be submitted. However, if medical documentation does not support an expedited process, the request will be subject to the normal timeframe.
| Electronic submission method | Submission instructions | Additional resources |
|---|---|---|
| SPOT |
SPOT is a FREE, secure internet portal for Part A and B providers to use to easily connect directly to First Coast. SPOT provides quick access to several time-saving features. To submit a prior authorization request, select the Secure Documentation option from the SPOT toolbar and then select Prior Authorization Requests Form from the drop-down menu. |
To learn more and enroll with SPOT, visit the SPOT website. |
| Fax |
The fax to image option allows for documentation to be submitted directly First Coast: Fax number 1-855-815-3065 Faxes should not exceed 200 pages |
For more information, visit PA program for RSNAT. |
| esMD |
Providers may submit a prior authorization request for certain hospital OPD services electronically through esMD: Indicate document/content type "8.5". |
To sign up for esMD, visit Electronic Submission of Medical Documentation (esMD) on the CMS website. |
First Coast offers free education on the submission methods described above. Access the following to learn more:
- Events Calendar
- On-Demand Learning education
Back to the Avoid the wait home page to explore more topics and options for electronic submission: