Claims

Published 1/1/2020

How Do I File Part A Claims to Medicare?

  • File via Electronic Claim Media (EMC): Most facilities submit claims electronically or employ a clearinghouse to submit claims electronically for them.
  • Direct Data Entry (DDE): Providers may manually use Direct Data Entry (DDE) to submit their claims directly into the Fiscal Intermediary Shared System (FISS). However, the DDE program is usually used in tandem by facilities that electronically submit claims because of the functionality it offers. Providers are able to access various files, correct returned claims, see reports, check their financial claim summary and see the status and location of their processing claims. 
  • PC-ACE PRO32: CMS required Medicare Administrative Contractors (MACs) to offer free billing software to providers. Small providers may download the free PC-ACE PRO32 software to submit and manage their claims.
  • File via Paper: Some providers that meet exceptions to mandatory electronic billing are allowed to submit CMS-1450 paper claim forms. To see if you qualify for an exception, please reference page six of the The Medicare Learning Network (MLN) Booklet Medicare Billing Form CMS-1450 and the 837 Institutional
Claims must be filed to the appropriate MAC no later than 12 months, one calendar year, from the date of service. Timely filing is determined by the date a processable claim is received by the appropriate MAC. Claims that are rejected as unprocessable are not considered submitted claims for the purposes of determining timely filing. Rejected claims must be corrected and resubmitted no later than 12 months from the date of service. Medicare will deny claims received after the deadline date. 

For more information on timely filing including the limited exceptions to the 12-month timely filing period, see IOM Pub. 100-04, Chapter 1 (PDF, 1.62 MB), Section 70 — Time Limitations for Filing Part A and Part B Claims.

For information on submitting a request for a timely filing extension, see Checklist for Timely Filing Extension.


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Checklist for Timely Filing ExtensionNew Medicare Beneficiary Identifier (MBI) Get It, Use ItPart A Providers Receiving MBI Edit (30995) for Claims Received prior to January 1, 2020Medicare Beneficiary Identifier (MBI) Required Starting January 1, 2020Medicare Beneficiary Identifier (MBI) ReminderMedicare Beneficiary Identifier (MBI) Lookup ToolFrequently Asked Questions: Recovery Audit ContractorRESOLVED: Sequestration Reduction Applied to April 2, 2021, PIP and Passthrough Payments in ErrorCMS MLN Fact Sheet: Medical Record Maintenance and Access RequirementsJJ Part A (Georgia Only) PIP and Pass-through Payments DelayedRESOLVED: Multiple Procedure Payment Reduction (MPPR) TOB 22X, 23X and 85XChecklist for Timely Filing ExtensionReason Code 10420Reason Code 15431Reason Code 19201Reason Code 19301Reason Code 30906Reason Code 30949Reason Code 31014Reason Code 31102Reason Code 31300Reason Code 31337Reason Code 31409Reason Code 31600Reason Code 31860Reason Code 32114Reason Code 32242Reason Code 32352Reason Code 32415Reason Code 34538Reason Code 34905Reason Code 34932Reason Code 34961Reason Code 34977Reason Code 34978Reason Code 37541Reason Code 37544Reason Code 38032Reason Code 39910Reason Code 39934Reason Code 52MUEReason Code 53MUEReason Code C7252Reason Code 70024Reason Code C7113Reason Code C7715Reason Code C7800Reason Code U5061Reason Code U6819Reason Code W7006Reason Code W7062Reason Code W7088Reason Code W7099Reason Code W7112Reason Code 5D508Reason Code U6825Reason Code 55503Reason Code 38119Reason Code 32404Reason Code 31398Reason Code 31413Reason Code 32078Reason Code 30912Reason Code 31593Reason Code 19401Reason Code 31094Reason Code 14610Reason Code 38117Reason Code 31256Reason Code 31023Reason Code 32073Reason Code 31255Reason Code U5607Reason Code U5233Reason Code 15701Reason Code 31608Reason Code C7080Reason Code 12205Reason Code 30955Reason Code 30905Reason Code 11503Reason Code 12505Reason Code 17701Reason Code 31605Reason Code 13599Reason Code 12818Reason Code 31346Reason Code 13314Reason Code 1461AReason Code 31406Reason Code 31486Reason Code C7010Reason Code 31257Reason Code 30949Reason Code 12302Reason Code 12206Reason Code 12811Reason Code 15202Reason Code 37205Reason Code W7040Reason Code 39132Reason Code 54NCDReason Code 51MUEReason Code U5210Reason Code 31241Reason Code U5200Reason Code 30940Reason Code 38038Reason Code 38200Reason Code 39929Reason Code 53NCDReason Code 31814Reason Code 32402Reason Code 39011Reason Code 31947Reason Code 31324Reason Code 30928Reason Code 31276Reason Code 31689Reason Code 32105Reason Code 32400Reason Code 56900Reason Code 5J504CPT Modifier 1PCPT Modifier 22Capital Related Assets Adjustment for the Transitional Add-On Payment Adjustment for New and Innovative Equipment and SuppliesRESOLVED: Fiscal Year 2022 Skilled Nursing Facility Claim ReprocessingOPEN: Claims Rejected in Error with Reason Code C7252OPEN: COVID-19 Claim Issue with NEW ICD-10 Codes Effective April 1, 2022JJ Part A Top Ten Claim Submission Error Analysis for January Through March 2022OPEN: Canceled Claims posted to CWF for 2022 Dates of Service Caused Processing IssuesSave Time and a Phone call - Check Your Claim Status and DetailsJuly 2022 Quarterly Release Temporary HoldJuly 2022 'Dark Days' for the Common Working File HostsReason Code 1282HOPEN: Default Health Insurance Prospective Payment System Code ZZZZZ Pricing Incorrectly on Type of Bills 18x and 21xRESOLVED: CY 2022 End-Stage Renal Disease Claim Reprocessing InstructionsOPEN: Outpatient Claims with Reason Code W7120 Returned in Error