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CGS Administrators, LLC

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Electronic Claims

The submission of claims in an electronic format is a requirement for the vast majority of DME suppliers. Enrolling in the CEDI (Common Electronic Data Interchange) program should be a first step for most DME suppliers. Enrollment into CEDI for DME suppliers is handled by the CEDI Contractor.

Submitting claims electronically provides several benefits:

  1. Faster payment. Electronic claims are paid earlier than paper claims. If you file paper claims, you will not be paid before the 29th day after the date of receipt of your claims (i.e., a 28-day payment floor). However, clean claims filed electronically can be paid as early as 14 days after receipt (i.e., a 13-day payment floor).
  2. Earlier detection of claim errors. Claims submitted electronically immediately go through a series of editing, reducing the likelihood of claims being denied for payment.
  3. CMN and DIF electronic submission. There is no need to submit a copy of the CMN or DIF unless requested. Electronic claim submission includes the ability to transmit information from the CMN or DIF electronically.
  4. Ability to submit additional documentation. When submitting claims to the DME MAC, you have the option of mailing, faxing or using esMD to send hard copy or electronic documentation to accompany your electronically-submitted DMEPOS claims. This is accomplished through the use of what is called the PWK (paperwork) segment.
  5. Access to other transactions. In addition to billing claims electronically, suppliers are also able to take advantage of other electronic transactions such as Remittance Advice, Claim Status and Medicare beneficiary eligibility data.

How to Submit Electronically

There are several methods available for suppliers to submit claims to the DME MAC in an electronic format:

Enrollment in CEDI

Contact the CEDI Contractor at NGS CEDIExternal Website to enroll in electronic claims processing and find information about other electronic transactions that are available to you.

Related Information

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