Claim Submission - JA DME

• CMS-1500 Claim Form Guidelines and Tips - Follow these claim guidelines to avoid processing delays, denials or inaccurate payments
• CMS-1500 Claim Form Instructions - View required claim form instructions and item specific tips, where necessary
• CMS-1500 Claim Form Tutorial - View image of claim form and move cursor over Items for claim form completion details
• Claim Line Maximums to Prevent Claim Lines Splitting During Processing - When submitting claims there are specific guidelines regarding claim line maximums. View details.
• Claim Narratives - There are many situations that a claim will require a narrative on the claim for the claims processing to complete timely. View some of these situations
• Common Abbreviations to Use as Narratives - View common abbreviations for use in the NTE 2400 (line note) or NTE 2300 (claim note) segments of the electronic claim format. These abbreviations may also be used in Item 19 of the CMS-1500 hard copy claim form.
• Definition and Filing - View claim for payment definition and which contractor to submit a claim to
• ICD-10 - Access ICD-10 information and resources
• Place of Service - View two-digit numeric place of service codes used for claim completion
• Submitting Claims When the Billed Amount Exceeds $99,999.99 - View instructions for billing claims when total of claim contains more than seven characters.

General

• 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 - Items billed with any HCPCS code with a narrative description that indicates miscellaneous, NOC, unlisted, or non-specified, must also include information in the narrative of the claim to identify the item. 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