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Claim Submission Timeliness Calculator

 



 

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Claim Submission

Claim Submission

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 Agreement - An assignment agreement is between a supplier of services and a Medicare beneficiary. View details
  • Claim Status Inquiry (CSI) - CSI allows suppliers to check eligibility and claim status. Suppliers can check the status of claims within three days of a successful transmission. This is not the Noridian Medicare Portal (NMP)
  • 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
  • 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
  • Health Insurance Claim Number (HICN) Prefixes and Suffixes - View definitions of beneficiary Medicare number prefixes and suffixes
  • 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
  • PECOS Edits - The edits ensure ordering/referring provider is enrolled in Provider Enrollment, Chain & Ownership System (PECOS). View background and implementation details
  • 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
  • Signature Requirements - Signatures by both the beneficiary and supplier are required for claim submission. View rules and one time authorization details
  • Timely Filing - View timely filing requirements for claim submission

 

Last Updated May 04, 2018