Claims


How Do I File Home Health and Hospice Claims to Medicare?

  • File via Electronic Claim Media (EMC): Most facilities submit claims electronically or employ a clearinghouse to submit claims electronically for them.
  • File via Direct Data Entry (DDE): Providers may manually use direct data entry (DDE) to submit their claims directly into the Fiscal Intermediary Shared System (FISS). However, the DDE program is usually used in tandem by facilities that electronically submit claims because of the functionality it offers. Providers are able to access various files, correct returned claims, see reports, check their financial claim summary and see the status and location of their processing claims. 
  • File using PC-ACE PRO32: CMS required Medicare Administrative Contractors (MACs) to offer free billing software to providers. Small providers may download the free PC-ACE PRO32 software to submit and manage their claims.
  • File via Paper: Some providers that meet exceptions to mandatory electronic billing are allowed to submit CMS-1450 paper claim forms. To see if you qualify for an exception, please reference page six of the The Medicare Learning Network (MLN) Booklet Medicare Billing Form CMS-1450 and the 837 Institutional.
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.




Checklist for Timely Filing ExtensionNew Medicare Beneficiary Identifier (MBI) Get It, Use ItMedicare Beneficiary Identifier (MBI) Required Starting January 1, 2020Medicare Beneficiary Identifier (MBI) Lookup ToolMedicare Beneficiary Identifier (MBI) ReminderRESOLVED: Home Health: PCR Duplicate Request RejectionsCMS MLN Fact Sheet: Medical Record Maintenance and Access RequirementsOPEN: Home Health Core-Based Statistical Area (CBSA) Code 50007 Payment IssueOPEN: Home Health Claims with Post-Acute Stay in an Inpatient Rehabilitation Unit or a Psychiatric Unit of a Critical Access Hospital Within 14 Days of the Home Health AdmissionChecklist for Timely Filing ExtensionRESOLVED: Home Health Claims Editing for Reason Code 31755RESOLVED: Home Health: Medicare System Not Recoding the Health Insurance Prospective Payment System (HIPPS) Code on Some ClaimsReason Code U6825Reason Code U6805Reason Code U5233Reason Code C7080Reason Code C7010Reason Code 39929Reason Code 39011Reason Code 319471650119201195043090830914321623296834927Reason Code 11501Reason Code 12102Reason Code 13599Reason Code 1461AReason Code 15701Reason Code 30928Reason Code 30949Reason Code 31102Reason Code 31276Reason Code 31282Reason Code 31287Reason Code 31313Reason Code 31418Reason Code 31428Reason Code 31485Reason Code 31503Reason Code 31566Reason Code 31605Reason Code 31689Reason Code 31755Reason Code 32030Reason Code 32032Reason Code 32105Reason Code 32243Reason Code 32400Reason Code 32402Reason Code 32403Reason Code 32404Reason Code 32445Reason Code 32710Reason Code 32907Reason Code 34923Reason Code 34952Reason Code 37236Reason Code 37238Reason Code 37253Reason Code 37257Reason Code 37402Reason Code 37541Reason Code 38050Reason Code 38055Reason Code 38107Reason Code 56900Reason Code 5Z72FReason Code N5052Reason Code U5106Reason Code U5111Reason Code U5150Reason Code U5157Reason Code U5181Reason Code U5194Reason Code U5200Reason Code U5211Reason Code U538FReason Code U538IReason Code U5391Reason Code W7A01Reason Codes 38031, 38157, 38158 and 38200Reason Codes 39071, 39072, 39073Reason Code 5J504RESOLVED: Hospice High/Low Payment Rates for Routine Home Care (RHC)April 2022 Quarterly Release Temporary HoldApril 2022 Release 'Dark Days' for the Common Working File HostsRESOLVED: Home Health: Payment on Claims When the Requests for Anticipated Payment Were Submitted More than 30 Days LateRESOLVED: Home Health Possible Overpayments on Partial Episode Payments (PEPs)Save Time and a Phone call - Check Your Claim Status and DetailsRESOLVED: Home Health 2022 Payment Adjustment for the Home Health Value-Based Purchasing ModelRESOLVED: Suspension of Home Health Claims with Reason Code 39910 When the Requests for Anticipated Payment (RAP) Were Submitted More than 30 Days LateRESOLVED: April 7, 2022, Remittance Advice Details for SC Part A, Home Health and Hospice ProvidersOPEN: Home Health Notice of Admission (NOA) Reason Code U537F, Home Health Admission OverlapOPEN: Home Health: 32G Adjustments Are Recoding the Health Insurance Prospective Payment System (HIPPS) Codes from Late to Earlier Periods on Home Health Claims When There Is Separation Between the Periods of Less than 60 DaysOPEN: Some Home Health RCD Postpayment Adjustments, 32I Type of Bill, Are Incorrectly Changing Patient Status to 01: Discharge to Home

Last Updated: 04/01/2016