Appeal status lookup – Part B help guide

The appeals status lookup tool enables providers to check the status on active redeterminations to confirm if the appeal has been received by First Coast Service Options.

When using the appeals status lookup, all fields are required.

1. First, select your line of business (Part A or Part B) for the Medicare Plan field. Note: If you do not select your line of business first, the remaining dropdown menus for each field will be unavailable.

2. Next select your location (Florida, Puerto Rico, or the U.S. Virgin Islands).

3. Select the third drop down to search by Case Control Number (CCN), Provider Transaction Access Number (PTAN), or PTAN and Internal Control Number (ICN). The appropriate numbers should be entered into the Value field or PTAN/ICN for that option.

How do I submit an Appeal online?

You can submit an Appeal online through our eServices tool. If you have an EDI Agreement on file with Medicare, you can register for eServices. If you are already a registered user in eServices you can immediately begin submitting Appeals through our ‘Secure Forms’ section of the tool.

The ‘Secure Forms’ section is on the ‘Messaging/Forms’ tab. This is on the menu once you successfully log in. You should see the ‘Secure Forms’ button to access available forms. Answer the questions on the page, and the forms available will appear as links at the bottom of the page.

Once you select the option to submit a ‘Secure Form,’ a pre-populated form will appear with the information we have on file from your registration record. This will save you several steps. Then fill in all the information that is required for an appeal request (they are highlighted with red ‘asterisks’). Be sure to add attachments to support your appeal request. You may attach an unlimited number of PDF attachments to each form. Each attachment can be up to 40 MB in size. The total size of all attachments on each ADR form can be no more than 150 MB.  

If you have any difficulties in uploading attachments or submitting the form, view our FAQ ‘How do I upload attachments to an Appeal request’ for more information.

How do I upload attachments to an Appeal request?

You may add attachments up to 40 megabytes (MB) each to a form. While there is no longer a limit to the number of files that can be attached to this form, the combined size of all attachments cannot exceed 150 MB. All attachments must be PDF documents. Most scanners have the ability to save documents in the PDF format. If you receive an error when uploading the file, your form will refresh with the error listed at the top of the page, and the PDF will no longer be attached. Errors can occur if the PDF is corrupt or if it was not created using PDF software. For example, you cannot change a file extension to PDF. It will not be in the correct PDF format and you will be unable to upload it.

If your file is over 40 MB, you will want to break it down into smaller files in order to attach it to your form. You can do this through your PDF software or by changing your original files and creating the PDFs again.

How can I check the status of my Appeal request submitted through eServices?

When you are logged into eServices, you can use the Document Control Number (DCN) that is assigned to your request to look up form processing status and view your submitted forms. When you open the confirmation email that has the DCN, you can click on the DCN in the message to look up the status of your form. In addition, you may view the documents you submitted by clicking on the View Documentation button.

When you are logged into eServices, you can also access the status look-up by clicking the ‘Get Status’ button on the Messaging/Forms tab. You will need to input the DCN to view the status through this screen.

Where do I find the CCN?

• CCNs may be obtained through searching the tool by PTAN
• You may call the Interactive Voice Response (IVR) follow the prompts to select status information followed by claim status.

Where do I find the ICN?
• ICNs may also be obtained from your remittance advice.
• You may call the Interactive Voice Response (IVR) follow the prompts to select status information followed by claim status.

4. Once all fields have been completed click the Submit button. Note: Providers with multiple appeal records may experience a slower loading time. Please allow up to 30 seconds for the results to load. We appreciate your patience.

To search using another value, click the Search Again link above the results.

Results are sorted by case received date. You may sort by any category, ascending or descending, by clicking on the column header. To change the order, simply click the column header again.

If multiple pages of results are found, use the scrolling menu bar to view the bottom results. You may also use the page number and/or arrow links found at the top or bottom of the results to view different pages. Note: You may experience a slight delay when changing pages. We appreciate your patience.
Important reminders

• Please allow 15 days after you have submitted your appeal request before checking its status in the lookup tool or contacting customer service.

• Appeals involving multiple claims may be identified by searching on the first claim listed on your request for redetermination. There will not be a separate listing for each claim on the redetermination.

• Once the request has been received, First Coast may take up to 60 days to issue a written decision on the redetermination request.

• Please keep in mind that the status tool is only as accurate as the data supplied to First Coast on the

Redetermination Request form. Status cannot be located if data was missing from your redetermination.

• Appeals which have been finalized will no longer display in the tool.

Check the status of your appeal

Once your redetermination request has been finalized, you may use SPOT to check the status of your claim. Be sure to use the new internal control number (ICN) number you received when you submitted your request. You may also use the Interactive Voice Response (IVR) system to check the status of your claim once your appeal has been finalized.

If a claim appeal has been finalized, it will not display in the appeal status search tool. Providers will receive correspondence within 15 days notifying them of the results of their appeal.

Claim reconsideration

If a provider is not satisfied with First Coast’s redetermination decision, they may take the claim to the second level of appeal: reconsideration. A qualified independent contractor (QIC) conducts all claim reconsideration requests. The QIC reconsideration process allows for an independent review of medical necessity issues by a panel of physicians or other health care professionals. A minimum monetary threshold is not required to request reconsideration. First Coast offers online forms for providers to contact the QIC to review their reconsideration request.