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 JBHCPCS Modifier ETHCPCS Modifier GHCPCS Modifier MGHCPCS Modifier GQHCPCS Modifier QPHCPCS Modifier GYHCPCS Modifier GSHCPCS Modifier V6HCPCS Modifier CHHCPCS Modifier Q4HCPCS Modifier Q5CPT Modifier 8PHCPCS Modifier GBHCPCS Modifier Q8HCPCS Modifier URHCPCS Modifier QTHCPCS Modifier NHCPCS Modifier Q9HCPCS Modifier KZHCPCS Modifier QDHCPCS Modifier XEHCPCS Modifier PIHCPCS Modifier JAHCPCS Modifier Q3CPT Modifier 66HCPCS Modifier F6HCPCS Modifier GXHCPCS Modifier AKHCPCS Modifier CCPT Modifier 2PHCPCS Modifier PAHCPCS Modifier JDHCPCS Modifier EAHCPCS Modifier TSHCPCS Modifier RCHCPCS Modifier Q6HCPCS Modifier QLHCPCS Modifier MBHCPCS Modifier CTCPT Modifier 59CPT Modifier 50HCPCS Modifier F9HCPCS Modifier AFHCPCS Modifier USHCPCS Modifier MHHCPCS Modifier QYHCPCS Modifier T6HCPCS Modifier GVHCPCS Modifier T2HCPCS Modifier GZHCPCS Modifier WHCPCS Modifier PTHCPCS Modifier UQHCPCS Modifier RRHCPCS Modifier UCPT Modifier 80HCPCS Modifier DHCPCS Modifier F8CPT Modifier 73HCPCS Modifier GOHCPCS Modifier FBHCPCS Modifier GPHCPCS Modifier QJHCPCS Modifier CLHCPCS Modifier T4HCPCS Modifier EJHCPCS Modifier GGHCPCS Modifier FACPT Modifier 77HCPCS Modifier E2HCPCS Modifier XSCPT Modifier 47HCPCS Modifier CSHCPCS Modifier ATHCPCS Modifier F1HCPCS Modifier XHCPCS Modifier LRHCPCS Modifier AZHCPCS Modifier TAHCPCS Modifier Q7HCPCS Modifier E1HCPCS Modifier APHCPCS Modifier SWHCPCS Modifier CJHCPCS Modifier G7HCPCS Modifier PSHCPCS Modifier GEHCPCS Modifier RTHCPCS Modifier FYCPT Modifier 53CPT Modifier 74HCPCS Modifier FCPT Modifier 22HCPCS Modifier RIHCPCS Modifier ECHCPCS Modifier CKHCPCS Modifier JWCPT Modifier 82CPT Modifier 23HCPCS Modifier MDHCPCS Modifier T8HCPCS Modifier G9HCPCS Modifier AGHCPCS Modifier F5HCPCS Modifier EYHCPCS Modifier SGCPT Modifier 1PHCPCS Modifier UPHCPCS Modifier QSHCPCS Modifier YOHCPCS Modifier CBHCPCS Modifier SCHCPCS Modifier IHCPCS Modifier SHCPCS Modifier QXHCPCS Modifier AJHCPCS Modifier REHCPCS Modifier HHCPCS Modifier COCPT Modifier 63HCPCS Modifier GCHCPCS Modifier CICPT Modifier 91HCPCS Modifier QZHCPCS Modifier F2HCPCS Modifier TCHCPCS Modifier Q1HCPCS Modifier RHCPCS Modifier RAHCPCS Modifier UEHCPCS Modifier GMHCPCS Modifier CQHCPCS Modifier ASHCPCS Modifier V7HCPCS Modifier OHCPCS Modifier BLHCPCS Modifier T9HCPCS Modifier T7HCPCS Modifier F7HCPCS Modifier T1HCPCS Modifier MECPT Modifier 62HCPCS Modifier CRHCPCS Modifier VPHCPCS Modifier DACPT Modifier 51HCPCS Modifier F4HCPCS Modifier JHCPCS Modifier XUHCPCS Modifier BAHCPCS Modifier AYHCPCS Modifier PBHCPCS Modifier T3HCPCS Modifier MAHCPCS Modifier PDHCPCS Modifier LMHCPCS Modifier F3HCPCS Modifier GNHCPCS Modifier E4HCPCS Modifier EBHCPCS Modifier JCHCPCS Modifier MCHCPCS Modifier AAHCPCS Modifier CGCPT Modifier 76HCPCS Modifier LCCPT Modifier 24HCPCS Modifier LTHCPCS Modifier PHCPCS Modifier LDHCPCS Modifier FXHCPCS Modifier XPHCPCS Modifier QCModifier Lookup: Your Resource for Correct Claim SubmissionHCPCS Modifier AQHCPCS Modifier Q0HCPCS Modifier GAHCPCS Modifier G0CPT Modifier 52HCPCS Modifier NUHCPCS Modifier QQHCPCS Modifier GWHCPCS Modifier AIHCPCS Modifier QWHCPCS Modifier G8CPT Modifier 3PHCPCS Modifier MDCPT Modifier 81HCPCS Modifier PCHCPCS Modifier T5HCPCS Modifier CMCPT Modifier 57HCPCS Modifier E3HCPCS Modifier GHCPT Modifier 26HCPCS Modifier ADHCPCS Modifier AHHCPCS Modifier GUHCPCS Modifier FCHCPCS Modifier UNHCPCS Modifier EHCPCS Modifier BOHCPCS Modifier AEHCPCS Modifier QKHCPCS Modifier GJHCPCS Modifier MFCPT Modifier 90HCPCS Modifier CNHCPCS Modifier LSLipid Panels: Medical Necessity DenialsE/M Service: Global Surgery DenialsUnlisted Supplies: Bundling DenialsVenipuncture: Statutory DenialsSkilled Nursing Facility: Not Covered by This Payer (Consolidated Billing Denials)Chiropractic Manipulative Treatment DenialsDiagnostic Cardiology Services: Medical Necessity DenialsEKG, EKG Rhythm Strip and Cardiac Echography: NCCI Bundling DenialsEstablished Patient Office Visits: NCCI Bundling DenialsCLIA Certification Number RequiredCode/Modifier Combination Invalid and Modifier Invalid/MissingChest X-ray or EKG: Duplicate DenialsClinical Laboratory Procedures: Duplicate DenialsAnesthesia Services: Bundling DenialsHot or Cold Packs: Bundling DenialsEye Refraction: Statutory DenialsHospice: Non-Attending Physician DenialsVenipuncture: Not Covered by This Payer (Facility Setting)X-Rays: Denied for ChiropractorsElectronic Claim Required: DenialsE/M Service: Duplicate DenialsNPI: Troubleshooting RejectionsProvider Certification DenialsReason Code CO-96: Non-covered ChargesNCCI Bundling DenialsDuplicate Denials: Compliance MattersCLIA: Laboratory TestsGlycosylated Hemoglobin A1C: Medical Necessity DenialsE/M Services: CCI Bundling DenialsSubmitted to Incorrect Program: 'Jurisdiction' DenialsE/M Service: Similar Services from Multiple Providers in the Same GroupPhysical & Occupational Therapy and Speech Language Pathology Caps: Financial Limitation DenialsNew Medicare Beneficiary Identifier (MBI) Get It, Use ItMedicare Beneficiary Identifier (MBI) Required Starting January 1, 2020Medicare Beneficiary Identifier (MBI) ReminderMedicare Beneficiary Identifier (MBI) Lookup ToolCPT Modifier 54Routine Physical Exams: Statutory DenialsTop Reasons for Claim Denials and RejectionsClaims with Cost-Sharing Is Waived Modifier Rejected in ErrorCARC 22CARC 181CARC 109CARC 18CPT Modifier 55CMS MLN Fact Sheet: Medical Record Maintenance and Access RequirementsHCPCS Modifier KXMSP: Eligibility & DenialsSave Time and a Phone call - Check Your Claim Status and DetailsMedicare Payments DelayedCPT Modifier 78CPT Modifier 58CPT Modifier 79CPT Modifier 25RESOLVED: Platelet Rich Plasma LCD (L38745) and Coverage Article (A58282)RESOLVED: Some Part B Claims and Ambulance Prior Authorization Claims Are Rejecting in ErrorChecklist for Timely Filing ExtensionRESOLVED: Part B Deductible and Coinsurance Applied to Some Oncology Care Model (OCM) Claims in ErrorRESOLVED: New Codes for an Additional Dose of the Pfizer and Moderna Vaccines for COVID-19OPEN: Clinical Laboratory Claims Possibly Pricing Incorrectly on Claims With More Than 14 Claim Detail LinesOPEN: Withhold (WO) Information Missing From Some Remittance AdviceOPEN: NCCI Edits for Some Vaccine Administration CodesRESOLVED: Hypoglossal Nerve Stimulation LCD (L38276) and Coverage Article (A58075)