Section 3 of the Administrative Simplification Compliance Act ( ASCA), Public Law (PL) 107-105, and the implementing regulation at 42 CFR 424.32 require that all initial claims for reimbursement under Medicare (except from small providers) be submitted electronically as of October 16, 2003, with limited exceptions. Initial claims are those claims submitted to a Medicare fee-for-service Part B carrier, durable medical equipment Medicare administrative contractor ( DME MAC), or Part A fiscal intermediary for the first time, including:
- resubmitted previously rejected claims;
- claims with paper attachments;
- demand claims;
- claims where Medicare is secondary and there is only one primary payer, and
- nonpayment claims.
Medicare is prohibited from payment of claims submitted in a non-electronic manner that do not meet the limited exceptions criteria. Claims required to be submitted electronically effective October 16, 2003, and later must comply with the appropriate claim standards adopted for national use under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The mandatory electronic claim submission requirement does not apply to claims submitted by beneficiaries or by suppliers that only furnish services outside of the United States, claims submitted to Medicare managed care plans, or to health plans other than Medicare.
Reference the Centers for Medicare & Medicaid Services ( CMS) Internet-Only Manual ( IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 24, Section 90 for further details on ASCA.
Refer to the following resources for more information detail on the ASCA enforcement process:
To correctly file an ASCA waiver, complete the ASCA Waiver Request form
When completing the ASCA Waiver Request Form please remember the following:
- The Waiver Request form must be completed and approved in order to send paper claims to National Government Services, even when an ASCA exception is met.
- The Waiver Request form must be completed for each provider and group number in order to send paper claims.
- Supporting documentation must be included for each provider and group number separately.
- ASCA Waivers can take 4–8 weeks to process.
- The Electronic Data Interchange Help Desk cannot address ASCA waiver inquiries; all ASCA inquires must be directed through the National Government Services Customer Care Contact Center.
Please mail your completed Waiver Request form to:
National Government Services, Inc.
Attention: ASCA
P.O. Box 7073
Indianapolis, Indiana 46207-7073
Note: An incomplete Waiver Request form is subject to denial. |