Several Cahaba units perform the various functions required to process Part B claims.
Most claims are submitted electronically and a section of this web site is dedicated exclusively to these claims. Please see What is EDI? for more details.
In our Front End Control/Mail Operations Department units, paper claims received are sorted and scanned using Image Character Recognition (ICR) technology. They are then repaired using software for ICR claims and uploaded into the Multi-Carrier System (MCS) or are entered directly into the Multi-Carrier System (MCS) as needed. After the claims are received in MCS, they are cycled through various edits and audits. Claims requiring manual intervention at this stage are resolved in the Claims Department units.
Who Can File Paper Claims
On August 15, 2003, the Department of Health and Human Services (HHS) published the Final Rule for Electronic Submission of Medicare Claims. This rule implements the statutory requirements found in the Administrative Simplification Compliance Act (ASCA). ASCA requires (with few exceptions) all claims sent to the Medicare Program be submitted electronically starting October 16, 2003. ASCA was enacted by Congress to improve the administration of the Medicare program by increasing efficiencies gained through additional electronic claims submission. Although 86.1% of Medicare claims are submitted electronically, the volume of paper claims is substantial, and moving from paper to electronic submissions has the potential for significant savings for Medicare physicians, practitioners, suppliers, and other health care providers, as well as for the program itself. This rule sets forth the details for implementation of the Medicare electronic claims submission requirement and who may be exempt from these requirements.
The rule is available at http://www.hhs.gov/ocr/privacy/hipaa/administrative/index.html.
The regulation requires that all claims submitted to Medicare on October 16, 2003 and beyond be done so electronically except for certain circumstances including:
- The provider is a small provider: less than 25 Full Time Employees (FTEs) for institutional setting and less than 10 Full Time Employees (FTEs) for professional setting;
- Dental claims;
- Claims where there is more than one payer primary to Medicare;
- Roster billing for vaccinations;
- Claims for Medicare demonstration projects
While these claims may be submitted electronically, it is not required if they meet the circumstances above.
For additional information, refer to
InSite Web Portal
- InSite is a FREE service that allows providers and suppliers to conduct business via an online web portal instead of using the IVR or calling the Provider Contact Center. You can use this system to find beneficiary eligibility and entitlement information; query for your claims status; and view your provider/supplier demographic information.
Other Claim Resources