Become a Medicare Expert
You have now completed all required steps to become a Medicare Provider, but there's still a lot to learn. Please review the links and information below to learn how to file successful claims, submit required paperwork to CMS in a timely fashion, and stay up to date on Medicare processes and news.
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This index provides definitions for commonly used acronyms and Medicare terminology.
Our Provider Contact Center (PCC) is here to help answer questions and resolve issues.
How Do I File Claims?
Submitting claims accurately is one of the most important things you will do as a Medicare provider. Our Claims section will walk you through the different ways you can file a claim, as well as help resolve any claim denials you experience.
The Advanced Communication Engine (ACE) Is Really SMART!
If you submit claims via the Electronic Data Interchange (EDI) option (Step 2), our ACE tool will return pre-adjudicated Part B claims information through a claim acknowledgement transaction report, called a Medicare 277CA report. Submitters will receive this report with ACE Smart Edits if a claim contains a potential submission error that requires the submitter's attention.
Smart Edits generate rejection alerts that provide submitters with granular messaging or educational awareness related to billing issues identified with their claim submission. The ACE tool affords you the opportunity to correct your billing issues prior to the claim being adjudicated in the claims processing system, allowing for more efficient and accurate claims processing.
Easy Access to LCDs and NCDs
National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) explain what items and services are covered by Medicare.
Understanding Your Remittance Advice
After your claim has been processed, you will receive a Remittance Advice containing information about your claim's payment, adjustments, denials, refunds, offsets, and more.
Filing an Appeal
Claims can be denied for a variety of reasons, but you can file an appeal if you feel it was denied incorrectly.
Learn about overpayments and recoupments.
A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers.