Claims


How Do I File Part A Claims to Medicare?

  • File via Electronic Claim Media (EMC): Most facilities submit claims electronically or employ a clearinghouse to submit claims electronically for them.
  • Direct Data Entry (DDE): Providers may manually use Direct Data Entry (DDE) to submit their claims directly into the Fiscal Intermediary Shared System (FISS). However, the DDE program is usually used in tandem by facilities that electronically submit claims because of the functionality it offers. Providers are able to access various files, correct returned claims, see reports, check their financial claim summary and see the status and location of their processing claims. 
  • PC-ACE PRO32: CMS required Medicare Administrative Contractors (MACs) to offer free billing software to providers. Small providers may download the free PC-ACE PRO32 software to submit and manage their claims.
  • File via Paper: Some providers that meet exceptions to mandatory electronic billing are allowed to submit CMS-1450 paper claim forms. To see if you qualify for an exception, please reference page six of the The Medicare Learning Network (MLN) Booklet Medicare Billing Form CMS-1450 and the 837 Institutional
Claims must be filed to the appropriate MAC no later than 12 months, one calendar year, from the date of service. Timely filing is determined by the date a processable claim is received by the appropriate MAC. Claims that are rejected as unprocessable are not considered submitted claims for the purposes of determining timely filing. Rejected claims must be corrected and resubmitted no later than 12 months from the date of service. Medicare will deny claims received after the deadline date. 

For more information on timely filing including the limited exceptions to the 12-month timely filing period, see IOM Pub. 100-04, Chapter 1 (PDF, 1.62 MB), Section 70 — Time Limitations for Filing Part A and Part B Claims.

For information on submitting a request for a timely filing extension, see Checklist for Timely Filing Extension.





Claims Articles


Reason Code U5210Reason Code 39132Reason Code U5200Reason Code 32105Reason Code 38038Reason Code 39929Reason Code 37205Reason Code 38200Reason Code 31814Reason Code 53NCDReason Code 54NCDReason Code 30940Reason Code 31324Reason Code 31241Reason Code 31276Reason Code 13314Reason Code 14610Reason Code 12818Reason Code 31346Reason Code 31255Reason Code 31947Reason Code U5233Reason Code 19401Reason Code 31398Reason Code 31023Reason Code 1282HReason Code 31413Reason Code 30905Reason Code U6825Reason Code 31608Reason Code 31593Reason Code 31256Reason Code 32402Reason Code 17701Reason Code 56900Reason Code U5607Reason Code 51MUEReason Code 30949Reason Code 15202Reason Code 15701Reason Code W7040Reason Code 13599Reason Code 31259Reason Code 32404Reason Code 31094Reason Code 11503Reason Code 31257Reason Code C7080Reason Code 31605Reason Code 38117Reason Code 12505Reason Code 31486Reason Code 32073Reason Code 12811Reason Code 12302Reason Code 38119Reason Code U6805Reason Code 32400Reason Code 31406Reason Code 30928Reason Code 32078Reason Code 12206Reason Code 30912Reason Code 31102Reason Code 52MUEReason Code 34932Reason Code C7800Reason Code 39910Reason Code 34978Reason Code 19301Reason Code W7099Reason Code 31337Reason Code C7715Reason Code 31860Reason Code 31409Reason Code 37541Reason Code 34538Reason Code 30949Reason Code 37544Reason Code U5061Reason Code C7252Reason Code 31689Reason Code U6819Reason Code 38032Reason Code 30906Reason Code 34961Reason Code 10420Reason Code 34977Reason Code 32352Reason Code W7062Reason Code W7006Reason Code 32114Reason Code 31689Reason Code 32415Reason Code C7272Reason Code 32242Reason Code W7088Reason Code 53MUEChecklist for Timely Filing ExtensionNew Medicare Beneficiary Identifier (MBI) Get It, Use ItPart A Providers Receiving MBI Edit (30995) for Claims Received prior to January 1, 2020Medicare Beneficiary Identifier (MBI) Required Starting January 1, 2020Medicare Beneficiary Identifier (MBI) ReminderMedicare Beneficiary Identifier (MBI) Lookup ToolReason Code 39934Frequently Asked Questions: Recovery Audit ContractorRESOLVED: Sequestration Reduction Applied to April 2, 2021, PIP and Passthrough Payments in ErrorReason Code 1461AReason Code 12205Reason Code 70024Reason Code 15431CMS MLN Fact Sheet: Medical Record Maintenance and Access RequirementsHCPCS Modifier KXSave Time and a Phone call - Check Your Claim Status and DetailsReason Code 19201Reason Code 30955JJ Part A (Georgia Only) PIP and Pass-through Payments DelayedRESOLVED: Multiple Procedure Payment Reduction (MPPR) TOB 22X, 23X and 85XRESOLVED: SNF 21X TOB Adjusted in ErrorRESOLVED: Reason Code U7515 and 39930Reason Code 55503Reason Code C7010Reason Code W7112Reason Code 39011Checklist for Timely Filing ExtensionOPEN: Claims for ICD-10-CM Code M54.5 Denying in ErrorOPEN: Some Outpatient Department Prior Authorization Claims (OPA) are Editing for Reason Code 39621 IncorrectlyRESOLVED: Suspension of Outpatient Prospective Payment System (OPPS) Claims Bill Types 12X, 13X, or 34X with COVID-19 Vaccine and Monoclonal Antibodies Services for Medicare Advantage BeneficiariesRESOLVED: Reason Code 37549