Claims Requiring Fax Documentation


Palmetto GBA Railroad Medicare now offers the availability of a fax service for electronic submitters to submit additional documentation with the claim. Certain services require a fax be submitted as acceptable documentation for the following situations when required by your local Part B Medicare Administrative Contractor (MAC):

  • Radiopharmaceutical drugs (e.g., HCPCS codes A9552/A9555)
    • When submitting claims for HCPCS codes A9552 and A9555, an invoice is required with each claim in order to determine the appropriate payment
  • Compounded drugs used in a pump
  • Drugs that are infused through Durable Medical Equipment (DME) require an invoice in order to determine the appropriate payment
  • Claims submitted with the following CPT modifiers: 22, 52, 53, 62, 63 and 66
  • Unlisted codes
  • HCPCS codes J3490 and J3590

For paper claims, include the actual invoice as an attachment. For electronic claims, enter the word 'fax' in the documentation record. Then, using the appropriate fax cover sheet, fax the actual invoice with the claim.

The fax documentation may be sent the same day the electronic claim is submitted or one to two days prior to the submission of the electronic claim. The documentation must be accompanied by the completed Railroad Medicare Faxed Documentation for Electronic Claims coversheet.

This fax cover sheet should not be used for any other purpose. You may download the Railroad Medicare Fax Documentation Cover Sheet on our website. Fax the completed form to:

 

EDI Fax Cover Sheet Fax To
For Documentation for Electronic Claims (803) 264-9842

When submitting the claim, the word 'fax' must be indicated in the documentation record of the electronic claim. Failure to indicate the word 'fax' may result in an incorrect payment or a denial of a claim.





Last Updated: 02/18/2021