CMS Clarifies Medicare Claims Process

The Centers for Medicare & Medicaid (CMS) recently rescinded Transmittal 1557, released July 18, and replaced it with Transmittal 1588, released Sept. 5, to clarify specific business requirements.

Effective Sept. 18, Medicare contractors are instructed to consider incomplete claims submitted on CMS-1490S and CMS-1500 forms that were filed in a timely fashion. Providers and suppliers have up to 6 months to resubmit corrected claims on the CMS-1490A form.

Providers and suppliers are required by law to submit Medicare claims for covered and non-covered services on behalf of beneficiaries. To submit claims, however, providers must be enrolled in the Medicare program. This does not apply to foreign beneficiary claims submitted for covered services or to DMEMACS for durable medical equipment, prosthetics, orthotics, and supplies.

Any claimant who submits an incomplete claim will receive a notification letter from the Medicare contractor processing the claim with an explanation of the corrections needed in order to process it correctly and in a timely fashion. A letter explaining the statutory requirement for providers and suppliers to submit claims for all services rendered to Medicare patients will also be sent.

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2 Responses to “CMS Clarifies Medicare Claims Process”

  1. Trailblazer Sux says:

    Trailblazer is HORRIBLE at processing applications and assisting providers. We’ve been trying to get our number from them for over a year and are getting no help whatsoever via the phone, fax or otherwise. You can imagine the claims we have backed up because of them.

  2. Linda Joy Adams says:

    How about my case. each claim turned into 17 and collections and one pay to provider. @ $3 million dollars missing from Medicare trust fund. 15 phony medicare numbers created on me to do this. plus the 2 legit #’s from SSA. trying to find atty for false claims suit. oh yes! for a decade they’ve been faxing requests to Medicare coordination of Benefits to alter my official ins records that post from US Dept of labor bi-weekly. Nd in defiance of 2 Medicare judges’ rulings they illegally alter this. US atty’s calls it a RICCO case. Then diagnosis are manipulated to circumvent listing my claims are Workers comp and illegally paid under Medicare, even one pay is theft. To read more : query “Linda Joy Adams using Bing search engine, click washingtonpost.com for my personal blog page click on COMMENTS! One party said a trillion is owed back to Medicare over this illegal manipulation on behalf of the ins industry being allowed to ‘dump’ their legal obligations onto Medicare. Linda Joy Adams

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