Does Medicare Accept Paper Claims & How to File Them
Successfully submit your Medicare paper claims. Understand when they're accepted and get clear, practical guidance on the filing process.
Medicare processes claims to determine coverage and payment for healthcare services. While electronic submission is the generally preferred and most common method for providers to submit claims, paper claims are still accepted under specific circumstances. Understanding the requirements for paper submissions can help ensure proper processing.
When Paper Claims Are Used
The Administrative Simplification Compliance Act (ASCA) generally requires that all initial Medicare claims be submitted electronically. However, Medicare acknowledges situations where paper claim submissions are necessary or permitted. For instance, smaller healthcare providers who submit fewer than ten claims per month on average during a calendar year may be exempt from the electronic submission mandate.
Paper claims may also be used for services under certain Medicare demonstration projects that specifically require paper submission. In situations where Medicare is the secondary payer, and there are complexities such as multiple primary payers or varying allowed amounts, paper claims might be required. Beneficiaries themselves may also need to file a paper claim if their provider does not accept Medicare assignment or has not submitted the claim within the timely filing limit.
Information and Forms for Paper Claims
The primary form used for submitting paper claims for professional services to Medicare is the CMS-1500 (version 02/12). This standardized form is utilized by individual healthcare providers, practices, and other non-institutional entities to bill for outpatient services. Accurate completion of this form is essential for claims processing.
The CMS-1500 form requires specific categories of information for a successful submission. This includes patient demographic details such as the full name, address, date of birth, and sex, exactly as they appear on the Medicare card. Provider information, including the billing provider’s name, address, National Provider Identifier (NPI), and federal tax identification number, must also be clearly stated. Additionally, the form requires detailed service information, including diagnosis codes (ICD-10) to explain why services were provided, procedure codes (CPT/HCPCS) describing the services rendered, dates of service, and the charges for each service.
Official copies of the CMS-1500 form can be obtained from the U.S. Government Printing Office, various local printing companies, or office supply stores. When filling out the form, it is recommended to use uppercase letters for all data, avoid special characters unless explicitly required, and use an inkjet or laser printer to ensure readability for optical character recognition (OCR) processing. For patient and provider signatures, indicating “Signature on File” in the respective boxes is generally acceptable if a valid signature authorization is maintained.
How to Submit a Paper Claim
Once the CMS-1500 form has been accurately completed with all necessary information, the next step involves submitting it to Medicare. Paper claims, along with any required attachments, must be mailed to the appropriate Medicare Administrative Contractor (MAC) that serves the specific geographic region. The correct mailing address for the relevant MAC is typically listed on the claim form itself or can be found on the Medicare website.
When submitting the claim, it is important to include all required supporting documentation. This may consist of itemized bills from the healthcare provider and, for Medicare Secondary Payer (MSP) claims, a copy of the primary payer’s Explanation of Benefits (EOB). Attachments should be secured with paper clips rather than staples or tape to avoid damaging the documents during processing.
After mailing, the processing time for a clean paper claim generally takes around 30 days. In contrast, electronically submitted claims are typically processed more quickly, often within 14 calendar days. Beneficiaries can monitor the status of their claims by reviewing the Medicare Summary Notice (MSN) received in the mail or by logging into their secure Medicare account online. Claims must be filed within 12 months, or one calendar year, from the date the services were provided.