Claims


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.





Claims Articles


HCPCS Modifier NCPT Modifier 80HCPCS Modifier XSHCPCS Modifier QLHCPCS Modifier T4HCPCS Modifier MDHCPCS Modifier UNHCPCS Modifier GXHCPCS Modifier E3CPT Modifier 24CPT Modifier 81CPT Modifier 82HCPCS Modifier FXHCPCS Modifier GEHCPCS Modifier T3HCPCS Modifier UHCPCS Modifier CLHCPCS Modifier XPHCPCS Modifier PCHCPCS Modifier MEHCPCS Modifier EJHCPCS Modifier PIHCPCS Modifier DACPT Modifier 50HCPCS Modifier FYHCPCS Modifier MDHCPCS Modifier Q6CPT Modifier 66HCPCS Modifier JWHCPCS Modifier WHCPCS Modifier F7HCPCS Modifier CTHCPCS Modifier ATHCPCS Modifier F9HCPCS Modifier QQCPT Modifier 62HCPCS Modifier LRHCPCS Modifier Q1HCPCS Modifier GPCPT Modifier 25HCPCS Modifier EAHCPCS Modifier PTCPT Modifier 91HCPCS Modifier MAHCPCS Modifier XEHCPCS Modifier ECCPT Modifier 26HCPCS Modifier FCHCPCS Modifier USHCPCS Modifier FAHCPCS Modifier SCHCPCS Modifier QXHCPCS Modifier AQHCPCS Modifier CBHCPCS Modifier QDHCPCS Modifier PHCPCS Modifier G7HCPCS Modifier MGHCPCS Modifier T2Modifier Lookup: Your Resource for Correct Claim SubmissionHCPCS Modifier LSHCPCS Modifier GQHCPCS Modifier T6HCPCS Modifier ETCPT Modifier 63CPT Modifier 47HCPCS Modifier T5HCPCS Modifier PBCPT Modifier 76HCPCS Modifier LTHCPCS Modifier PDCPT Modifier 1PHCPCS Modifier Q8HCPCS Modifier G8HCPCS Modifier GACPT Modifier 3PHCPCS Modifier E2HCPCS Modifier Q0HCPCS Modifier JDHCPCS Modifier V6HCPCS Modifier AFHCPCS Modifier CJHCPCS Modifier EBHCPCS Modifier GVCPT Modifier 8PHCPCS Modifier GYCPT Modifier 22HCPCS Modifier YOCPT Modifier 79HCPCS Modifier GBHCPCS Modifier CMHCPCS Modifier GOHCPCS Modifier RHCPCS Modifier GJCPT Modifier 57HCPCS Modifier CRHCPCS Modifier MFHCPCS Modifier QPHCPCS Modifier BOHCPCS Modifier T8HCPCS Modifier LDHCPCS Modifier F4HCPCS Modifier PAHCPCS Modifier TCHCPCS Modifier CSHCPCS Modifier AKCPT Modifier 78HCPCS Modifier HHCPCS Modifier AZCPT Modifier 52HCPCS Modifier CHHCPCS Modifier T7HCPCS Modifier V7HCPCS Modifier AAHCPCS Modifier RRHCPCS Modifier CIHCPCS Modifier UEHCPCS Modifier 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90HCPCS Modifier GWHCPCS Modifier TAHCPCS Modifier BLHCPCS Modifier QYHCPCS Modifier AJHCPCS Modifier EHCPCS Modifier GNHCPCS Modifier F6HCPCS Modifier JCHCPCS Modifier GHCPCS Modifier Q5HCPCS Modifier RIHCPCS Modifier NUHCPCS Modifier G9CPT Modifier 51HCPCS Modifier GUHCPCS Modifier SGHCPCS Modifier QKHCPCS Modifier UPHCPCS Modifier Q3HCPCS Modifier GZHCPCS Modifier MHHCPCS Modifier EYHCPCS Modifier MBHCPCS Modifier GMHCPCS Modifier LMCPT Modifier 77HCPCS Modifier APHCPCS Modifier AHHCPCS Modifier ADHCPCS Modifier SWHCPCS 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/MissingPhysical & Occupational Therapy and Speech Language Pathology Caps: Financial Limitation DenialsCLIA: Laboratory TestsE/M Service: Duplicate 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Office Visits: NCCI Bundling DenialsReason Code CO-96: Non-covered ChargesRESOLVED: Pembrolizumab Injection Medically Unlikely EditRESOLVED: Ustekinumab (Stelara)RESOLVED: Belimumab (Benlysta)RESOLVED: COVID-19 Antibody TestingRESOLVED: Telehealth Procedure Codes and Skilled Nursing Facility Consolidated Billing EditsRESOLVED: COVID-19 Tests: HCPCS U0003 and U0004RESOLVED: Monjuvi (Tafasitamab-cxix) Claims Rejected in ErrorRESOLVED: Interim Final Rule CMS-5531-IFC: CPT Code 99211 EditingIncorrect Denials for Beneficiary Date of DeathRESOLVED: Jurisdiction J Part B Provider Payments DelayedChecklist for Timely Filing ExtensionNew Medicare Beneficiary Identifier (MBI) Get It, Use ItMedicare Beneficiary Identifier (MBI) Required Starting January 1, 2020Medicare Beneficiary Identifier (MBI) ReminderMedicare Beneficiary Identifier (MBI) Lookup ToolRESOLVED: Waived Laboratory Billing Requirement for Ordering/Referring Professional for COVID-19 Public Health EmergencyCPT Modifier 54Top Reasons for Claim Denials and RejectionsRoutine Physical Exams: Statutory DenialsClaims with Cost-Sharing Is Waived Modifier Rejected in ErrorCARC 22CARC 18CARC 181CARC 109CPT Modifier 55RESOLVED: Electronic Funds Transfer (EFT) Payments DelayedRESOLVED: 2021 Anti-Inhibitor Coagulant Complex PricingRESOLVED: Revised 2021 Clinical Laboratory Fee Schedule (CLFS)RESOLVED: Overlapping or Duplicative Chronic Care Management ServicesRESOLVED: National Correct Coding Initiative Procedure-to-Procedure Coding Pair UpdatesWhy did my patient's MBI change and which MBI do we use?CLIA Waived Modifier