Hardcopy Claim Submission Exceptions and Required Cover Form
CMS requires most Medicare claims to be submitted electronically or through Direct Data Entry (DDE). First Coast can only accept paper claim submissions in limited circumstances.
Accepted Hardcopy Claim Submission Exceptions
- Administrative Simplification Compliance Act (ASCA) exceptions
- ASCA generally prohibits payment of paper-submitted claims except in limited situations, such as certain small providers.
- 935 adjustments or cancels
- Medicare Secondary Payer (MSP) claim cancels
- MSP claims may also be adjusted or canceled electronically or through DDE/FISS.
- MSP tertiary claims
- Tribal Self-Funded adjustments
- Disaster-related claims
- Includes national or facility-specific disasters.
- A detailed explanation of the disaster circumstance is required.
- Military Treatment Facility (MTF) emergency service claims
- Applies to U.S. Department of Defense (DoD)-operated hospitals.
Hardcopy Adjustments and Cancellations
When submitting a paper adjustment or cancellation:
- Complete the appropriate Hardcopy Adjustment and Cancel Request Form.
- Attach the form to the UB-04 (CMS-1450) claim form.
- Whenever possible, submit adjustments and cancellations electronically, as this is the preferred method.
Electronic Adjustment and Cancel Requests
First Coast allows providers to submit adjustments and cancellations electronically, including claims with denied lines.
Do not alter denied lines in any way.
To help claims process correctly, include detailed remarks explaining why the adjustment or cancellation is needed.
Example:
- If canceling an outpatient claim (Type of Bill 13X) because it overlaps an inpatient claim (Type of Bill 11X) during the three-day payment window, include the remark "Overlapping an inpatient claim".
- Using this specific language may allow the claim to process without manual intervention. Other remarks may cause the claim to suspend for manual review.
Appeals for Denied Charges
If your goal is to overturn or reverse denied charges, do not submit an adjustment or cancellation request. Instead:
- Follow the Medicare appeals/redetermination process.
- Submit an appeal according to established Medicare guidelines.
If submitting a hardcopy adjustment or cancel claim, please complete and attach the Hardcopy Adjustment and Cancel Request Form, JN Hardcopy Request, to the UB-04 CMS–1450 claim form. Whenever possible, electronic adjustment and cancel requests are preferred.
If you are attempting to have denied charges reversed, please submit an appeal/redetermination following established protocol. For more information on appeals, please visit the Appeals, Reopenings, & Overpayments center on our website.
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