Claim Submission - JD 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 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 to use as narratives in Item 19 and 2400/NTE segment
• 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 - 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) West 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