Administrative Simplification Compliance Act (ASCA) FAQs
1. Why am I getting a letter requesting proof that I meet the requirements to submit paper claims to Medicare, when I have previously been granted a waiver to bill paper claims?
Waivers to bill paper claims are good for two years. After two years, CMS requires that we request documentation to verify that you still meet the requirements to submit paper claims. Please follow the instructions in the letter to submit the required documentation.
2. What records do I submit in response to a letter requesting documentation to show that we are eligible for a waiver to submit paper claims?
You can submit copies of your 941 tax report or payroll records for the most recent reporting period as proof that you meet the requirements for a small provider waiver.
3. How can I qualify for a waiver in order to submit paper claims to Medicare?
The Administrative Simplification Compliance Act (ASCA) requires that claims must be submitted electronically to Medicare unless the provider qualifies for an exception. The ASCA exceptions for Medicare Part B and documentation needed are as follows:
Exception Required Documentation Small providers with less than 10 full time equivalent employees Copies of your 941 tax report or payroll records for the most recent reporting period. Roster billers of Medicare covered mass immunizations Copy of your schedule for vaccination clinics Dental claims Copy of your dental license Claims for payment under Medicare demonstration projects when information is required that cannot be submitted electronically Claims where Medicare is the tertiary payer to two (or more) primary payers
You can fax the required documentation to (618) 998-5287, or mail it to
Medicare Part B
ASCA Unit
PO Box 8810
Marion, IL 62959
4. I am getting my Medicare Secondary Payer (MSP) claims denied because I am sending them on paper. My software does not allow me to bill MSP claims electronically. How do I get a waiver for my MSP claims?
MSP claims are not an exception to the ASCA requirements. All Medicare claims (see exceptions above) must be billed electronically. Please contact your vendor regarding their software's ability to send MSP claims electronically. If your vendor's software is not capable of filling out MSP claims, you can use another software or utilize the WPS Medicare's EDI department, which offers FREE software capable of sending MSP claims. The EDI staff is more than willing to assist you with obtaining and supporting this software. Contact numbers for EDI are listed at the bottom of this article.
5. Where do I get a waiver request form to send paper claims?
The ASCA Department does not have a waiver request form. The ASCA Monitoring Department will request documentation such as payroll hours for a quarter, a Federal 941 tax form showing the number of employees, a flu roster schedule or a dental license. Documentation is only requested from a provider that submits 31 or more paper claims in a quarter or has had a previous two-year waiver and received the ASCA development letters.
6. How do I contact the ASCA Monitoring Department?
Requests and responses for the ASCA Monitoring Department should be submitted in writing and can be faxed to (618) 998-5287. If you prefer to mail, please use the mailing address listed below. Please include your contact information on all correspondence.
Medicare Part B
Attn: ASCA Enforcement Review Unit
PO Box 8810
Marion, IL 62959
7. I have less than 10 employees. How can I file for a waiver?
If a provider files 31 or more paper claims in a quarter, they will be reviewed by the ASCA Monitoring Department. If you have less than 10 full time equivalent employees, then you will need to respond to the ASCA department with the correct documentation to receive a waiver which may allow you to continue to submit paper claims. You cannot file a waiver to submit paper claims unless you have received an ASCA development letter requesting information from you regarding paper claim submission.
For questions regarding your electronic claims or getting started filing electronically, contact the Medicare EDI Hotline at (877) 567-7261.
Page Last Updated: Monday, 01-Mar-2010 16:02:44 CST
