Become a Railroad Medicare Expert
You now have completed all the required steps to become a Railroad Medicare provider, but there’s still a lot to learn. Please review the links and information below to learn how to successfully file claims, review your remittance advice, and more.
Our Provider Contact Center (PCC) is here to help answer questions and resolve issues.
The Railroad Medicare Quick Reference Guide can help answer your questions.
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This index provides definitions for commonly used acronyms and Medicare terminology.
How Do I File Part B Claims to Railroad Medicare?
- Most providers submit electronic ANSI 837P claims. You are ready to submit claims electronically if you have completed Step 2 of this guide.
- Providers that meet exceptions to mandatory electronic billing may be allowed to submit CMS-1500 paper claim forms.
- eServices users also have the ability to submit paperless eClaims through the portal.
Submitting claims accurately is one of the most important things you will do as a Railroad 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.
What does Medicare Cover?
The CMS National Coverage Determinations and Medicare Benefit Policy Manual explain what items and services are covered by Medicare.
As a national Specialty Medicare Administrative Contractor, Railroad Medicare does not establish Local Coverage Decisions (LCDs) outside those LCDs which may be in use by the local A/B Medicare Administrative Contractors.
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. Find out how you can file an appeal if you feel a claim 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.