Become a Medicare Expert


You have now completed all required steps to become a Medicare Provider, but there's still a lot to learn. Please review the links and information below to learn how to file successful claims, submit required paperwork to CMS in a timely fashion, and stay up to date on Medicare processes and news.

How Do I File Claims?

Submitting claims accurately is one of the most important things you will do as a Medicare provider. Our Claims section will walk you through the different ways you can file a claim, as well as help resolve any claim denials you experience.

Claim Filing Instructions

The Advanced Communication Engine (ACE) Is Really SMART!

If you submit claims via the Electronic Data Interchange (EDI) option (Step 2), 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 this report with ACE Smart Edits if a claim contains a potential submission error that requires the submitter's 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.

Easy Access to LCDs and NCDs

National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) explain what items and services are covered by Medicare.

Medical Policies

Understanding Your Remittance Advice

After your claim has been processed, you will receive a Remittance Advice containing information about your claim's payment, adjustments, denials, refunds, offsets, and more.

Learn More

Filing an Appeal

Claims can be denied for a variety of reasons, but you can file an appeal if you feel it was denied incorrectly.

Get Started

Finance

Learn about overpayments and recoupments.

Learn More

Fee Schedules

A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers.

View Fees





Last Updated: 03/02/2021