An ASCA waiver request must be mailed per CMS instructions, using the address on the ASCA Waiver Request Form.
For Medicare Part A providers/facilities, Medicare requires a waiver and supporting documentation for each PTAN. For corporations that have multiple PTANs, a waiver request and supporting documentation is required for each PTAN.
For Medicare Part B solo practitioners, Medicare requires a waiver and supporting documentation for each PTAN. For corporations that have a group PTAN or have multiple group PTANs with Medicare, a waiver and supporting documentation would need to be submitted for each group PTAN.
An ASCA Waiver approval is only valid for two years. Once two years has passed, any provider/supplier who was previously granted an ASCA approval may be reviewed again.
If providers/suppliers meet the definition of a small provider/supplier, under the ASCA exceptions they are not required to submit claims electronically. It is possible that a small provider/supplier may receive a Request for Documentation letter from National Government Services to establish whether or not they meet the criteria for submission of paper claims. If a small provider/supplier receives a Request for Documentation letter from NGS, follow the instructions and complete a Waiver Request form within the timeframe given. NGS will then notify providers/suppliers by mail if they can continue to submit paper claims. If a small provider/supplier does not reply to the letter or follow the instructions within the time frame given, their paper claims will be denied.
When providers submit an ASCA Waiver, additional documentation should be included. Listed below are examples of supporting documentation that should be sent with the applicable exception.
- Small Supplier: Payroll records (does not need to include salary information), tax records or a certified letter from a CPA.
- Roster Billing: A copy of a roster bill claim.
- Tertiary Claims: A copy of a tertiary claim.
- Unusual Circumstance: For software issues, a detailed letter from your software vendor on their letterhead. For billing issues, a letter with a detail description of the billing issue(s).
If an ASCA Waiver Request does not establish eligibility to submit paper claims, National Government Services will notify the provider/supplier by mail that any paper claims received by a specified date will be denied.
National Government Services will notify providers/suppliers by mail of the outcome.
Mail completed ASCA waiver request forms to:
National Government Services, Inc.
P.O. Box 7022
Indianapolis, IN 46207-7022