SPOT features and functionality

1099 forms

Submit and retrieve 1099 forms

ACO REACH

Obtain Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model information

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Appeal requests

Submit appeal requests with documentation  

Appeal status

Obtain information regarding status of appeals, including the outcome and copies of redetermination notices

AR transaction information

Obtain account receivable details including recoupment, adjustment, collection amounts, and duplicate demand letters

Claim correction

Make basic corrections to claims that include the number of services or units, diagnosis codes, procedure codes and certain history corrections

Claim correction confirmation

Receive confirmation on claim correction submissions

Claim status

Obtain the status of a claim that is accepted into the claim processing system

Claim submission / ERA

Upload 837 claim files for processing and download 835 ERA files to review claim processing outcomes

Claim summary

View claim summary information per provider such as the number of claims approved to

process, claims pending, and more 

Comparative billing report (CBR)

Obtain reports, which provide insight into billing trends, and assist providers with self-audits of procedures and billing practices

Credit balance report submission

Submit quarterly credit balance reports electronically, rather than by mail 

DCN lookup

Lookup document control number (DCN) information 

Demand letter / overpayment details 

Obtain overpayment / demand letters and corresponding financial details

Eligibility

Check patient eligibility and obtain benefit details

FCN lookup

Lookup financial control number (FCN) information 

General inquiry

Submit general inquiries such as questions related to coverage guidelines, policy issues, or how to bill Medicare

MBI lookup tool

Look up patient Medicare beneficiary identifier (MBI) numbers

Medical review claims

View additional documentation request (ADR) status and dates, copies of ADR letters, and status and outcome of the review

Medical records / ADR

Respond to both Claim and Medical ADR requests for additional information or medical record submissions

MSP overpayment refund

Submit a request for an MSP overpayment to be performed

Non-MSP overpayment refund

Submit a request for a non-MSP overpayment to be performed

Overpayment correction

Submit corrections to claims that were overpaid. 

Overpayment demand letters

View, save, or print copies of overpayment letters

Overpayment redetermination

Report a duplicate claim, services not rendered, or other correction on a single line or full claim.

Payment status

Obtain check information such as check number, amount, dates, and check status. 

Prior authorization requests

Part A and B: 

• Hospital outpatient department (OPD) services

Part B only:

• Submit prior authorization requests for Part B repetitive non-emergent ambulance transportation

Provider audit and reimbursement

Submit documentation to Provider Audit & Reimbursement including supplemental security income (SSI) realignment requests, wage index / occupational mix submissions, cost report reopening requests, and more

Provider data summary

Submit documentation to Provider Audit & Reimbursement including supplemental security income (SSI) realignment requests, wage index / occupational mix submissions, cost report reopening requests, and more

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Remittance advice

View, save, or print copies of the remittance like the standard paper remittance (SPR)

Submission history

Review submission history details