Claim Submission Timeliness Calculator


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Claim Submission


  • Administrative Simplification Compliance Act (ASCA) - View ASCA purpose, supplier's responsibility, circumstances under which a supplier may submit paper claims, claim processing information
  • Assignment and Non-assignment of Benefits - An assignment agreement is between a supplier of services and a Medicare beneficiary. View details
  • Beneficiary Authorization - A request for payment signed by the beneficiary must be on file or submitted with each claim.
  • Billing Multiple Units of Service with the Same HCPCS Code and Same Date of Service - Suppliers should always bill multiple units of service with the same HCPCS code and the same date of service on one claim line. View exceptions
  • Claims Processing Timeliness Interest Rate - If payment is not made within 30 days (ceiling period) after date of receipt, interest must be paid on clean claims. View details
  • Clean Claims - Payment / Interest - A "clean" claim is one that does not require investigation or development outside the DME MAC operation on a prepayment basis. View details
  • Common Working File (CWF) - View information available in national system (CWF), hours it is available, and types of inquiries in which Noridian Interactive Voice Response (IVR) system and NMP
  • Crossover Claims - View Benefits Coordination & Recovery Center (BCRC) crossover claims and contact information
  • Date Span Requirements on Claims - View items that mandate the inclusion of a date span on all claims submitted to the DME MACs (Medicare Administrative Contractors)
  • Electronic Submission of Medical Documentation (esMD) - The intent is to reduce supplier costs and cycle time by minimizing and eventually eliminating paper processing and mailing of medical documentation. View details and resources
  • Incomplete or Invalid Claims Processing Terminology - View definitions of incomplete or invalid claims processing terminology
  • Jurisdiction List - View year specific lists to help suppliers determine which Medicare contractor to bill for certain HCPCS codes
  • Mandatory Claim Submission - Providers and suppliers must submit Medicare claims for all covered services on behalf of Medicare beneficiaries. View details
  • Medically Unlikely Edits (MUEs) - Maximum number of units of service, per HCPCS/CPT, a provider can report for a beneficiary on a date of service. Not all codes have an MUE. View details
  • Medicare Beneficiary Identifier (MBI) - Congress requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A randomly generated MBI will replace SSN-based Health Insurance Claim Number on new Medicare cards. View details
  • Not Otherwise Classified Codes - When billing for nuts, bolts, screws, or other small parts, these items are included in allowance for accessory with which they are being used. View details
  • Participating vs Non-participating Supplier - Participating vs Non-participating defines how the supplier enrolled to participate in the Medicare program with the National Provider Enrollment (NPE) East when they applied for their billing privileges as a Durable Medical Equipment, Orthotics and Supplies (DMEPOS) supplier
  • PECOS - Provider Enrollment, Chain & Ownership System (PECOS) is the online Medicare enrollment system for providers and suppliers.
  • PWK (Paperwork) - PWK is a segment within 837 Professional and Institutional electronic transactions which provides ‘linkage' between electronic claims and additional documentation necessary for claims processing
  • Sales Tax - Medicare does not reimburse separately for sales tax. View CMS Internet Only Manual (IOM) details
  • Timely Filing - View timely filing requirements for claim submission


Last Updated Jul 08 , 2024