Submitting Paper Claims
The Administrative Simplification Compliance Act (ASCA) requires that as of October 16, 2003, all initial Medicare claims be submitted electronically, except in limited situations. Medicare is prohibited from payment of claims submitted on a paper claim form that do not meet the limited exception criteria.
CMS has provided a listing of exceptions to electronic claim submission on its Administrative Simplification Compliance Act Self-Assessment Web page. Some of these include:
- Small provider claims
- Claims from providers that submit fewer than 10 claims per month on average during a calendar year
- Claims for payment under a Medicare demonstration project that specifies paper submission
In addition, CGS has identified the following situations where it may be necessary for home health and hospice providers to submit paper claims:
- Claims for dates of service that exceed Medicare timely filing guidelines
- Certain Medicare Secondary Payer (MSP) situations. For example, when a claim has been denied by the Federal Black Lung program and the provider is requesting Medicare payment (Please refer to the MSP Billing and Adjustments quick resource tool for more information on when it is appropriate to submit MSP claims on paper)
Prior to submitting any paper claims to CGS, home health and hospice agencies should conduct a self-assessment to determine if they meet one of the exceptions for electronic claim submission by accessing the CMS Administrative Simplification Compliance Act Self-Assessment Web page.
When appropriate, paper claims should be mailed to:
J15 — HHH Claims
CGS Administrators, LLC
PO Box 20019
Nashville, TN 37202
Please see the following resources that are available on this topic:
- Medicare Claims Processing Manual (Pub. 100-04, Ch. 24, §§90 – 90.6)
- CMS Administrative Simplification Compliance Act Self-Assessment Web page
- CMS Medicare Learning Network (MLN) Matters article, MM3440
- CMS Change Request 2966
Updated: 12.14.12
