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February 9, 2023

Benefits of Submitting Electronic Claims

Are you tired of completing the CMS-1500 claim form and mailing it to the DME MAC? Do you get rejected claims because something was missed on the form? There is a much better option: submit your claims electronically!

Per Chapter 6 of the DME MAC Supplier Manual, "Administrative Simplification Compliance Act (ASCA), Public Law (PL) 107-105, and the implementing regulation at 42 CFR 424.32, requires that all initial claims for reimbursement under Medicare (except from small providers) be submitted electronically as of October 16, 2003, with limited exceptions." Even if your business is allowed a valid exception (small supplier, dental claim, or you only submit a few claims a month), you can still submit your DME claims electronically.

Benefits of electronic submission include:

  • Saving money. Submitting claims electronically reduces postage and other paper-related expenses while increasing efficiency. No need to remember to order the red and white CMS-1500 claim forms any longer.
  • Saving time. Reduce the time it takes to complete the claim forms, reviewing the 30-plus items for accuracy, and mail them.
  • Faster payments. Electronic claims are paid earlier than paper claims.
    • Chapter 6 of the DME Supplier Manual states: "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)."
  • Free software. Common Electronic Data Interchange (CEDI) offers free billing software that is based on the requirements of the HIPAA-standard format. View the CEDI websiteExternal website for more information.
  • Catch errors early. Claims submitted electronically immediately go through a series of system edits, reducing the likelihood of denials. If there are errors, you will be able to respond more quickly because you will receive the Medicare Remittance Advice statement faster. Simply correct the errors and resubmit the claim in question.
  • Access to other transactions. Take advantage of other electronic transactions such as 835 – Electronic Remittance Advice (ERA). You can also file your Medicare as a Secondary Payer (MSP) claims electronically.
  • Submit documents with your claim. Filing electronically allows you to submit other documents with your claim. If you complete the PWK (paperwork) segment on the electronic claim form, this will alert us to the fact that you will fax or mail documents, and we will hold the claim (for up to 10 business days) until those related documents are received (we will hold the claim up to 10 business days). See the PWK webpage for more information.

After seeing these great benefits, are you ready to make the switch and submit your DME MAC claims electronically?

Originally published March 27, 2019. Revised February 2023.


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