ASCA Requirements for Paper Claim Submissions
The Administrative Simplification Compliance Act (ASCA)* requires that all Medicare claims are submitted electronically, with limited exceptions. Submitting electronic claims helps lower administrative costs for the Medicare program and your practice—and, you'll get paid faster too! With that in mind, we realize that sometimes the best solution may be to submit paper claims temporarily. Please see below for information on how to start submitting electronic or paper claims.
Submitting Electronic Claims
For information on how to enroll and start submitting electronic claims, visit the EDI section of the Web site.
Submitting Paper Claims
To submit paper claims to Medicare:
When completing the ASCA Waiver Request Form please remember the following:
Note: An incomplete ASCA Waiver Request Form is subject to denial.
ASCA Exception Criteria
Paper claims may only be submitted when one the following situations apply:
Refer to the following resources for further information on ASCA, including the limited exceptions, definition of a small provider, and more:
*Section 3 of the ASCA, Public Law 107-105, and the implementing regulation at 42 CFR 424.32.
Form(s) you'll need:
ASCA Mailing Address:
National Government Services, Inc.
P.O. Box 7022 | Indianapolis, IN 46207-7022
Benefits of Using EDI Transactions
There are a number of advantages to enrolling and submitting claims online. Claims and other transactions submitted electronically process considerably faster than paper submission. For example, HIPAA-compliant electronic claims are held in the payment floor for 14 days whereas paper claims are held in the payment floor for 29 days.
Some of the other advantages of electronic submission include:
Receive the Electronic Remittance Advice
ERA is an EDI transaction that allows you to receive payment information via e-mail or another electronic format. If you have the software, an ERA file created by Medicare can be automatically posted to your accounts receivable system. Once the ERA is in place, the payment posting process is more efficient and accurate. Other ERA benefits include:
Note: The SPR will be mailed for a minimum of 45 days after the provider number has been setup for ERA. If you submit through a billing service, clearinghouse, or a submitter/sender ID that is currently receiving ERAs, you will no longer receive the SPR effective with the completion of the ERA setup date.