Filing Paper Claims from NGS Medicare & CMS

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:

• You must meet one of the ASCA Exception Criteria 
• Complete the ASCA Waiver Request Form 
• Provide supporting documentation

When completing the ASCA Waiver Request Form please remember the following:

• The form must be submitted and approved by National Government Services in order to send paper claims, even when an ASCA exception is met. 
• The form and supporting documentation must be completed and sent for each PTAN for Part A and Part B providers.
  • For Medicare Part A corporations that have multiple PTANs, a waiver request and supporting documentation is required for each PTAN. 
  • For Part B corporations that have a group PTAN or multiple group PTANS, a waiver and supporting documentation must be submitted for each group PTAN.
• ASCA waivers will take 30 business days to process and receive notification on the outcome of your waiver request. 
• The EDI Help Desk cannot address ASCA waiver inquiries; all ASCA inquires must be directed through our Provider Contact Center.

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:

• You are a small practice: 
  • Small institution (hospital, facilities) with less than 25 full-time employees (Part A) 
  • Physician or other medical professional groups with fewer than 10 full-time employees (Part B)
• You are a dentist:
  The following situations where there is no method for submitting a claim electronically: 
  • Roster billing of vaccinations covered by Medicare
  • Claims for payment under Medicare demonstration projects 
  • Claims for services rendered outside of the United States 
  • Tertiary claims (MSP claims with one primary payer must be billed electronically)
• Unusual circumstances:
  • Service interruptions (e.g., breakdown or interruption in telephone or communications service)
  • Provider/supplier submits fewer than 10 claims monthly on average (less than 120 claims yearly) 
  • Other unusual circumstance (you must give a detailed explanation)

Related Content

Refer to the following resources for further information on ASCA, including the limited exceptions, definition of a small provider, and more:

• CMS Change Request 2966 (326 KB) 
• CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 24, Section 90 (1 MB) 
• Medicare University – take the ASCA CBT module 
• MLN Matters article MM3440

*Section 3 of the ASCA, Public Law 107-105, and the implementing regulation at 42 CFR 424.32.

Form(s) you'll need:

• ASCA Waiver Request Form

ASCA Mailing Address:

National Government Services, Inc.
Attn: ASCA
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:

• Increased cash flow and lower administrative costs 
• Ease of billing 
• Added efficiency and accurate claims filing

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:

• Faster communication and payment 
• Faster account reconciliation 
• Improves office productivity 
• Automation of follow-up action 
• Paperwork reduction 
• Detailed information

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.