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Claims Information
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.
- National Provider Identifier (NPI)
- Top Claim Submission Errors (CSEs) and How to Resolve
- Checking Claim Status
- Checking Beneficiary Eligibility
- Claims Filing
- Claims Filing Resources
- Deductibles and Co-insurance
- ELGA and ELGH Overview of Key Fields
- Resources for the Most Common Medicare Part A Provider Questions
- ZIP
Codes Requiring a Plus Four ZIP Code Extension
- UB-04 (CMS-1450)
The resources provided through our Web site 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.
Claims Filing
Paper Claims
Only a small percentage of providers continue to submit paper claims. The Centers for Medicare & Medicaid Services (CMS) encourages providers to utilize electronic billing because of the costs and delays associated with mailing, manual processing, and storage of paper claims. Electronic claims begin processing immediately upon claim receipt, thus reducing processing time while improving cash flow.
Electronic Claims
Electronic billing is often referred to as Electronic Data Interchange (EDI). To obtain the most current system requirements, enrollment forms, and other supporting information for EDI with Cahaba, refer to our EDI page. Once your EDI connections are complete, electronic claims can be entered one of two ways. Claims can be keyed directly into FISS (Direct Data Entry) or sent through a file transfer process.
Direct Entry
The process of keying claims from your site directly into FISS is known as Direct Data Entry (DDE). The DDE process allows claims to be edited while they are being entered so they can be corrected and processed through the system at a faster rate. This option works best for facilities with small claims volume.
File Transfer
The other option for electronic claims submission is file transfer. Claims are entered into third-party software designed by a vendor or your own in-house programmer. This third-party software is loaded on your PC and retains all of your beneficiary information. Entered claims are compressed and combined into a file and then transferred to Cahaba. The system will generate reports confirming receipt of the file. These reports can be downloaded for your records. This option works best for providers with a large claims volume or providers wanting specific features (e.g., patient records, accounts receivables) from a claims processing software package.
A variety of vendors offer Medicare claims software packages, and prices vary greatly according to the different features. Please visit the EDI page on our Web site for more information regarding third-party claims software.
Electronic Remittance Advice and Electronic Funds Transfer
Whether you do DDE or file transfer, two other benefits as an electronic biller include the Electronic Remittance Advice (ERA) and the Electronic Funds Transfer (EFT). The information contained in the ERA file is more detailed than the information provided on a paper remittance advice. EFT allows dollars to be directly deposited into your bank account. Your bank receives funds 24 to 48 hours after we release them. EFT eliminates mail service delays and trips to the bank to deposit Medicare checks. You do not have to submit claims electronically to take advantage of this EDI function. If you are interested in submitting claims electronically, refer to the EDI page on our Web site or e-mail EDI to request information.
TopClaims Filing Resources
Current Billing Information - Cahaba's Newsroom Web page provides a wealth of current information and developments affecting Medicare Claims filing and payment. Here are some of the key information resources to consult regarding claims billing issues.
- Medicare A Newslines - Cahaba's monthly newsletters provides the latest Medicare billing updates. This Web page allows you to view the current edition as well as search previous issues.
- What's New - A chronological listing of links to key billing and coverage developments
- E-mail notices - Receive important up-to-the-minute news from Cahaba regarding Medicare billing and system issues by subscribing to this useful e-mail notification system. Follow this link to learn more about subscribing to this service, visit E-Mail Subscription.
- CMS Press Releases -
Follow this link to access the Public Affairs Center on CMS' Web site.
Detailed Reference Materials
- FISS Reference Guide - This is a detailed guide to using the Fiscal Intermediary Standard System (FISS) for direct entry of claims, attachments; correcting claims; checking eligibility; etc.
- CMS Online Manuals -
Follow this link to CMS' Web site to access their system of online
Medicare Manuals. The CMS Online Manual System is used by CMS
program components, partners, contractors, and State Survey Agencies
to administer CMS programs. It offers day-to-day operating instructions,
policies, and procedures based on statutes and regulations, guidelines,
models, and directives. Specifically, Publication # 100-04 Medicare Claims Processing Manual may be a useful reference for your claims related issues.
Forms
- CMS Forms - Access billing and many other Medicare forms directly from CMS' Web site.
- Contacts - If you have a question regarding claims filing issues, your may call or write Cahaba by referring to our contacts page.
Frequently Asked Questions (FAQs)
- Cahaba FAQs - Review these frequently asked questions (FAQs), which are based on the most common inquiries the Cahaba has recently received from providers. The tips and references after each question may assist you in resolving these types of issues in the future.
- CMS FAQs - This is another good source of information that can be searched to help you with billing and other Medicare issues.
Page last updated: December 1, 2008
