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Submitting Paper Claims

The Administrative Simplification Compliance Act (ASCA) requires that as of October 16, 2003, all initial Medicare claims be submitted electronically, except in limited situations. Medicare is prohibited from payment of claims submitted on a paper claim form that do not meet the limited exception criteria.

Note: Generally, Medicare beneficiary's don't need to file Medicare claims. For services provided by home health and hospice providers, the provider must file the claim for you. For additional resources for Medicare patients, refer to the People with MedicareExternal Website web page.

CMS has provided a listing of exceptions to electronic claim submission on its Administrative Simplification Compliance Act Self-AssessmentExternal Website Web page. Some of these include:

  • Small provider claims
  • Claims from providers that submit fewer than 10 claims per month on average during a calendar year
  • Claims for payment under a Medicare demonstration project that specifies paper submission

In addition, CGS has identified the following situations where it may be necessary for home health and hospice providers to submit paper claims:

Prior to submitting any paper claims to CGS, home health and hospice agencies should conduct a self-assessment to determine if they meet one of the exceptions for electronic claim submission by accessing the CMS Administrative Simplification Compliance Act Self-AssessmentExternal Website Web page.

When appropriate, paper claims should be mailed to:

J15 — HHH Claims
CGS Administrators, LLC
PO Box 20019
Nashville, TN 37202

Please see the following resources that are available on this topic:

Updated: 03.10.20


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