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
Page Last Updated: Friday, 06-Nov-2009 14:16:20 CST
