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Electronic Claims

The submission of claims in an electronic format is a requirement for the vast majority of DME suppliers. Enrolling in the CEDI (Common Electronic Data Interchange) program should be a first step for most DME suppliers. Enrollment into CEDI for DME suppliers is handled by the CEDI ContractorExternal Website.

Submitting claims electronically provides several benefits:

  • Faster payment. If you file paper claims, you will not be paid before the 29th day after the date of receipt of your claims (i.e., a 28-day payment floor). However, clean claims filed electronically can be paid as early as 14 days after receipt (i.e., a 13-day payment floor).
  • Ability to send documentation. When submitting electronic claims to the DME MAC, you have the option of mailing, faxing or using esMD to send documentation to accompany claims. This is accomplished through the use of what is called the PWK (paperwork) segment.
  • Access to other transactions. In addition to billing claims electronically, suppliers are also able to take advantage of other electronic transactions such as Remittance Advice, Claim Status and Medicare beneficiary eligibility dataExternal website.

How to Submit Electronically

There are several methods available for suppliers to send claims to the DME MAC in an electronic format:

  • Free software. PC-ACE is a free billing software based on the requirements of the HIPAA-standard format. This software offers valuable features to help with electronic claim submission, archiving and reporting. Contact CEDI for more information.
  • CEDI Claims Portal. The CEDI Claims Portal is a web-based claim entry option available for suppliers who submit a small volume of claims.
  • Approved software vendor, Billing Service or Clearinghouse. CEDI publishes an Approved Entities List on their web site.

DME MAC Contractor Codes (Payer IDs):

  • Jurisdiction B: 17013
  • Jurisdiction C: 18003

Enrollment in CEDI

Contact the CEDI ContractorExternal Website to enroll in electronic claims processing and find information about other electronic transactions that are available to you.

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