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Claims

Before submitting claims to Medicare, it is critical that you check a beneficiary’s eligibility. Use the tools listed below to assist you in determining whether a beneficiary is entitled to Medicare Part A and/or Part B, enrolled in a Medicare Advantage (MA) or other insurance plan, or elected in a hospice benefit. You can also determine if the services on your claim will be affected by the consolidated billing requirements under Skilled Nursing Facility (SNF), Home Health (HH), or other Prospective Payment Systems (PPS). We encourage you to use these tools to help reduce claim errors, which cause delays in receiving Medicare payments.

The resources provided through our website are based upon Medicare regulations, instructions, and forms established by the Centers for Medicare & Medicaid Services (CMS). Please refer to these resources when filing your claims with Cahaba.

The claims filing regulations and instructions apply regardless of whether you submit the CMS-1450  claim on paper or electronically. The system used to process your Medicare claims is called the Fiscal Intermediary Standard System (FISS). If you have on-line access or enter your claims directly (direct data entry) into FISS, refer to the FISS Reference Guide for step-by-step instructions on how to enter, view, or correct your claims on-line.

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