Claims
Published 08/27/2024
How Do I File Part B Claims to Medicare?
- File Electronically: Most providers submit electronic ANSI 837P claims.
- Before filing claims electronically to Medicare, you must have an EDI enrollment packet on file with Palmetto GBA. See our Electronic Data Interchange (EDI) resources for more information on enrolling for electronic claim submissions.
- View the Electronic Filing Instructions (PDF)
- Palmetto GBA Interactive CMS-1500 Claim Form Instructions — This resource can also be helpful to providers who submit electronic claims. The help files for each CMS-1500 claim form field include the corresponding ANSI ASC 837P v5010 Loop, Segment, and Element, when applicable.
- File via Paper: Some providers that meet exceptions to mandatory electronic billing are allowed to submit CMS-1500 paper claim forms.
- The Administrative Simplification Compliance Act (ASCA) requires that Medicare claims be sent electronically unless a provider qualifies for an exception waiver. To see if you qualify for an exception, please reference page six of the Medicare Learning Network (MLN) Booklet Medicare Billing Form CMS-1500 and the 837 Professional (PDF).
- CMS Claim Filing Instructions
- File an eClaim: eServices users also have the ability to submit paperless eClaims through the portal.
- See section 4.6 of the eServices User Manual (PDF) for more information
- eServices Claim Submission (eClaim) Tips
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.