How Do I File Part B Claims to Medicare?

  • File Electronically: Most providers submit electronic ANSI 837P claims
    • Before filing claims electronically to Medicare, you must have an EDI enrollment packet on file with Palmetto GBA. See our Electronic Data Interchange (EDI) resources for more information on enrolling for electronic claim submissions.
    • View the Electronic Filing Instructions
    • Palmetto GBA Interactive CMS-1500 Claim Form Instructions — This resource can also be helpful to providers who submit electronic claims. The help files for each CMS-1500 claim form field include the corresponding ANSI ASC 837P v5010 Loop, Segment, and Element, when applicable.
  • File via Paper: Some providers that meet exceptions to mandatory electronic billing are allowed to submit CMS-1500 paper claim forms.
  • File an eClaim: eServices users also have the ability to submit paperless eClaims through the portal
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.

The Advanced Communication Engine (ACE) Is Really SMART!

If you submit claims via the Electronic Data Interchange (EDI) option, 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 the Medicare 277CA report with ACE smart edits if a claim is identified as containing a potential claim submission error that requires the submitters 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.

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Modifier COHCPCS Modifier GCHCPCS Modifier GSHCPCS Modifier GHCPT Modifier 53HCPCS Modifier JElectronic Claim Required: DenialsLipid Panels: Medical Necessity DenialsDiagnostic Cardiology Services: Medical Necessity DenialsHot or Cold Packs: Bundling DenialsCode/Modifier Combination Invalid and Modifier Invalid/MissingCLIA: Laboratory TestsE/M Service: Duplicate DenialsSkilled Nursing Facility: Not Covered by This Payer (Consolidated Billing Denials)Chiropractic Manipulative Treatment DenialsEKG, EKG Rhythm Strip and Cardiac Echography: NCCI Bundling DenialsNCCI Bundling DenialsSubmitted to Incorrect Program: 'Jurisdiction' DenialsHospice: Non-Attending Physician DenialsEye Refraction: Statutory DenialsChest X-ray or EKG: Duplicate DenialsGlycosylated Hemoglobin A1C: Medical Necessity DenialsVenipuncture: Statutory DenialsNPI: Troubleshooting RejectionsE/M Services: CCI Bundling DenialsCLIA Certification Number RequiredVenipuncture: Not Covered by This Payer (Facility Setting)Provider Certification DenialsE/M Service: Global Surgery DenialsDuplicate Denials: Compliance MattersAnesthesia Services: Bundling DenialsUnlisted Supplies: Bundling DenialsX-Rays: Denied for ChiropractorsClinical Laboratory Procedures: Duplicate DenialsEstablished Patient Office Visits: NCCI Bundling DenialsReason Code CO-96: Non-covered ChargesRESOLVED: Jurisdiction J Part B Provider Payments DelayedNew Medicare Beneficiary Identifier (MBI) Get It, Use ItMedicare Beneficiary Identifier (MBI) Required Starting January 1, 2020Medicare Beneficiary Identifier (MBI) ReminderMedicare Beneficiary Identifier (MBI) Lookup ToolTop Reasons for Claim Denials and RejectionsRoutine Physical Exams: Statutory DenialsCARC 22CARC 18CARC 109CMS MLN Fact Sheet: Medical Record Maintenance and Access RequirementsMSP: Eligibility & DenialsMedicare Payments DelayedCPT Modifier 78CPT Modifier 58CPT Modifier 79CPT Modifier 25Checklist for Timely Filing ExtensionAffinity: HCPCS Code Q4159 Requires InvoiceCARC 181HCPCS 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FTRESOLVED: Incorrect Coinsurance Percentage Applied for Drugs and BiologicalsHCPCS Modifier KXOPEN: Certain Amniotic Fluid and Placental Tissue Claims to Be Reopened and ReviewedOPEN: Medicare Improperly Paid Physicians for Spinal Facet-Joint Denervation SessionsRESOLVED: MCS Data Center Claim Data PurgeRESOLVED: Revised April 2022 Ambulatory Surgical Center (ASC) Drug File

Last Updated: 02/25/2021