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.





Claims Articles


32162Reason Code 34952Reason Codes 38031, 38157, 38158 and 38200Reason Code 30949Reason Code 31566Reason Code 13599Reason Code 15701Reason Code 32403Reason Code N5052Reason Code 12102Reason Code 37541Reason Code 32032Reason Code U5211Reason Code 32402Reason Code U5391Reason Code 38107Reason Code 3142816501Reason Code 32030Reason Codes 39071, 39072, 39073Reason Code U5150Reason Code 32243Reason Code 31503Reason Code 32404Reason Code 32907Reason Code 1461A32968Reason Code U5106Reason Code 37257Reason Code 37238Reason Code 31485Reason Code 38050Reason Code U538IReason Code 31313Reason Code 31287Reason Code U5157Reason Code 32710Reason Code U5111Reason Code 37402Reason Code 5Z72FReason Code 32445Reason Code 31755Reason Code 31102Reason Code U5194Reason Code 37253Reason Code 31689195041920130908Reason Code 11501Reason Code 3160530914Reason Code 38055Reason Code 3141834927Reason Code 37236Reason Code U5181Reason Code 34923Reason Code 31282Reason Code U5200Reason Code W7A01Reason Code 31276Reason Code 39929Reason Code 32105Reason Code 32400Reason Code 30928Reason Code U6805Reason Code 31947Reason Code C7080Reason Code U6825Reason Code U5233Reason Code 56900Checklist 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 RequirementsCoordination of Benefits: Parts A, B and HHH Crossover Claims IssueReason Code U538FSave Time and a Phone call - Check Your Claim Status and DetailsHome Health Possible Overpayments on Partial Episode Payments (PEPs) Reason Code C7010OPEN: 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 AdmissionReason Code 39011Checklist for Timely Filing ExtensionOpen: Hospice High/Low Payment Rates for Routine Home Care (RHC)RESOLVED: Suspension of Outpatient Prospective Payment System (OPPS) Claims Bill Types 12X, 13X, or 34X with COVID-19 Vaccine and Monoclonal Antibodies Services for Medicare Advantage BeneficiariesOpen: Home Health Low Utilization Payment Adjustments (LUPAs) Add-On PaymentsRESOLVED: RCD Choice 5 for North Carolina and Florida UpdateOPEN: Suspension of Home Health Claims with Reason Code 39910 When the Requests for Anticipated Payment (RAP) Were Submitted More than 30 Days LateOPEN: Some Home Health Pre-Claim Review (PCR) Claims are Editing for Reason Code 39621 Incorrectly