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This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
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Last Modified: 3/20/2024 Location: FL, PR, USVI Business: Part A, Part B

Claim submission 

Step 1: Choose your billing method

There are two general billing methods: electronic or paper submission.
Medicare does adhere to Administrative Simplification Compliance Act (ASCA) requirements. This requires all initial claims for reimbursement, except for small providers, be submitted electronically, with limited exceptions. Medicare will not accept claims submitted on paper that do not meet the limited exception criteria. To see if you qualify for these exceptions, refer to the Self-Assessment Form external link to determine if you are a small provider.
Electronic submission methods:
SPOT portal
Secure File Transfer Protocol (SFTP)
Third Party via a billing service or clearinghouse
For additional information on Electronic Data Interchange (EDI)
Part A:
CMS-1450 (UB-04) claims form in the National Uniform Billing Committee (NUBC) website external link
Part B:

Step 2: Submit the claim

After the claim submission option was selected, claims can be submitted. Claims must be submitted no later than 12 months, or one calendar year, after the date of service(s) were furnished. With few exceptions, claims received without an explanation for the late filing are generally assumed to be filed late and the provider accepts responsibility for late filing. Please refer to the CMS IOM Pub. 100-04 for further instructions.

Step 3: Check claim status

Upon receipt of a claim, a unique tracking number will be assigned to the claim. For Part A claims this is a document control number and Part B claims are an internal control number.
The payment floor establishes a waiting period during which time the contractor may not pay, issue, mail or otherwise finalize the initial determination on a clean claim. A clean claim is one that does not require the MAC to investigate or develop on a prepayment basis. Medicare has 30 days to pay the claim but cannot pay before the payment floor:
Electronic claims: 14 days from date of receipt of claim
Paper claims: 29 days from date of receipt of claim
There are multiple ways to check claim status:
SPOT
FISS (Part A only)
IVR:
Part B 877-847-4992
Part A 877-602-8816
Once a claim has processed through the Medicare system, a Medicare remittance advice will be sent to the provider of the service. Denial messages are utilized within the claims processing system and will determine which claim adjustment reason code/ remittance advice remark code will be entered. These codes will provide additional information as to whether the service was rejected, denied, or allowed.

Customer Contact Center

Interactive voice response (claims and eligibility information):
Part B: 877-847-4992, options 1, 2
Part A: 877-602-8816, options 2 or 5
Provider inquires:
Part B
PR: 877-715-1921
FL: 866-454-9007
Part A
PR: 877-908-8433
FL: 888-664-4112
Monday to Friday, 8 a.m. - 4 p.m. (ET)
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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.