ASCA Requirements for Paper Claim Submissions

Table of Contents

• ASCA Requirements for Paper Claim Submissions
  • Submitting Electronic Claims
  • Submitting Paper Claims
• ASCA Exception Criteria
• Related Content

[Return to Top]

ASCA Requirements for Paper Claim Submissions

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.

[Return to Top]

Submitting Electronic Claims

For information on how to enroll and start submitting electronic claims, visit the EDI section of the website.

[Return to Top]

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.

[Return to Top]

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:

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

• • • 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)

[Return to Top]

Related Content

• • CMS Change Request 2966
  • CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 24, Section 90