Credit Balance Reports: Submission Tips Meeting CMS Standards

The Credit Balance department is working on automation to assist with more quickly processing credit balance reports as they come in each quarter. To avoid rejection of your quarterly credit balance report, it is important to remember that your quarterly report submission must be complete, accurate, and comply with CMS standards. To assist you in ensuring your credit balance report is accepted and processed timely, please ensure your report is compliant with the reminders listed below:

  • A single CMS 838 report must be submitted for each PTAN. Multiple report submissions that break out inpatient and outpatient claims for the same PTAN cannot be processed through our new system. 
  • Detail page(s) must accompany the CMS 838 report. These should not be submitted separately.  Please submit your Credit Balance Detail Page before the end of the 30 day acceptance period in order for us to review your claims timely. Please take extreme care when filling our your Detail Page to avoid any PHI violations. Make sure the report is completely filled out, legible, and that the patients' Medicare ID numbers, ICNs and DOS are not cut off. Part A ICNs start with a 2, are 14 digits long, and have three or four letters on the end. If anything is missing, illegible or cut off, your report will be rejected and a letter will be sent to your facility.
  • Claim corrections sent electronically or by UB04 must be submitted by the following process:
    • When submitting a claim adjustment for an individual credit balance, complete the field locators (FL) required on an adjustment UB-04 claim or electronic equivalent. This includes the:
      • Type of Bill (FL 4), with the third digit of a "7";
      • Condition Code (FL 18-28) (when using a D9, enter an explanation of the adjustment in the Remarks field (FL 80);
      • Adjustment Reason Code on (FISS Page 03) MUST be a “CB” and;
      • Document Control Number (FL 64) of the claim being adjusted
    • When submitting a claim cancelation for an individual credit balance, complete the field locators (FL) required on a cancelation UB-04 claim or electronic equivalent. This includes the:
      • Type of Bill (FL 4), with the third digit of a "8";
      • Condition Code (FL 18-28) “D5” – cancel to correct provider/patient Medicare ID number or “D6” – cancel duplicate payment
      • Adjustment Reason Code on (FISS Page 03) MUST be a “CB” and;
      • Document Control Number (FL 64) of the claim being canceled
  • Only acceptable written signatures and titles should be on the CMS 838 report.  Per the instructions provided by CMS on page 2 of the Medicare Credit Balance Report – Provider Instructions (PDF, 793 KB), the CMS 838 form must be signed by an officer or administrator for the facility. If the form is not signed by an officer or administrator it will not be accepted. Please ensure the title of the authorized individual is clearly printed on the form.
  • The most current CMS 838 form must be used. This form can be found at the CMS.gov website as well as the Palmetto GBA website under Financial Forms. No other forms should be used, examples; old 838 forms, Cost Report form, Voluntary Refunds form, etc… Inclusion of other forms could result in your credit balance report being sent to an incorrect area and will delay processing.
  • Provider numbers are 6 digits (with exception of third digit being a T, S, U or Z) only and should not have an A or B on the end. Please do not confuse your Provider number with your NPI. If you use your NPI number on your report, it will be rejected.
  • Choose one submission process either by eServices, Fax, or mail. Double submitting, unless otherwise requested, creates a back log in our system and slows down the acceptance process.
  • 838 Reports submitted by Fax or mail may be delayed up to three business days before reaching the credit balance department. We strongly recommend submission using Palmetto GBA’s eServices option.
  • Be sure to select the CMS 838 option in the Palmetto GBA eServices portal when submitting the credit balance report. The cost report option should not be used to submit the CMS 838 report.  Doing so will result in delays in processing.

Credit Balance reports will be rejected and a letter will be sent to the facility as notification of the rejection if they do not conform to these standards. Please do not email/call to verify receipt of the CMS 838 report. If you would like a Palmetto GBA confirmation that we received your 838 report please use eServices. Please note that the confirmation is only for receipt of your 838 report not the acceptance of your report. If your report is not accepted you will be notified by rejection letter, email or phone call.

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