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Paper Claims

Section 3 of the Administrative Simplification Compliance Act (ASCA), Public Law (PL) 107-105, and the implementing regulation at 42 CFR 424.32, requires that all initial claims for reimbursement under Medicare (except from small providers) be submitted electronically as of October 16, 2003, with limited exceptions.

How to Receive Payment Sooner: File Electronically

Submitting claims electronically provides several benefits, including faster payment. Electronic claims are paid earlier than paper claims. 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).

In addition, claims submitted electronically immediately go through a series of editing, reducing the likelihood of claims being denied for payment.

Refer to the Electronic Claims page for additional information.

Small Providers:

If you are submitting paper claims because you are a small supplier, you may want to consider the CEDI Claims PortalExternal Website for quicker claims processing. The CEDI Claims PortalExternal Website is a web- based claim entry option available for suppliers who submit a small volume of claims.

Exceptions to Electronic Claim Submission

There are some exceptions to the electronic claim submission requirement that allow suppliers to continue to bill paper claims. The exceptions include the following (not all inclusive):

  1. You are a small provider. To qualify as a small provider, DMEPOS suppliers must have fewer than 10 full time employees (FTEs). A small provider can elect to submit all, some, or none of their claims electronically. The CEDI Claims PortalExternal Website is an electronic option for small suppliers.
  2. Claims sent to Medicare when more than one other insurer was liable for payment prior to Medicare (Medicare is the third payer).
  3. Claims submitted by suppliers that submit fewer than 10 claims a month to Medicare. The CEDI Claims PortalExternal Website is an electronic option for suppliers who submit a small volume of claims.

Refer to Chapter Six – Claim SubmissionPDF of the Jurisdiction C Supplier Manual for the complete list of exceptions.

How to Complete a Claim Form

The CMS-1500 claim form is the basic form created by CMS for use by suppliers. Before completing the form, you should determine if you are required to submit your claims electronically (which is standard for a majority of suppliers) or whether you qualify to submit your claims on paper.

For step-by-step instruction on completing a CMS-1500 claim form, please review Chapter Six – Claim Submission of the Jurisdiction C Supplier Manual.

Paper Claims should be mailed to the following address:

CGS – Jurisdiction C
P.O. Box 20010
Nashville, TN 37202

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