Can I Submit a Paper Claim?

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The short answer is, "it depends."

It’s no surprise that healthcare payers prefer to receive claims electronically. Electronic transmission is more efficient, less prone to error, and much faster than a paper-based process.



PROVIDERS WHO CAN SUBMIT THE CMS 1500 PAPER FORM

Small providers:​
Facilities (who file Medicare Part A claims) with fewer than 25 FTEs; OR
Physicians/Practitioners/Facilities (who file Medicare Part B or DME claims) with under 10 FTEs
Large providers who submit fewer than 10 claims on average to Medicare per month.
Providers who have experienced disruption in electricity or phone/communication services.
Non-Medicare Managed Care Organizations that bill Medicare for copayments.

There are other exceptions related to types of claims – including, for example, dental claims. And, of course, CMS and other payers accept paper claims from patients.

For more detail on any of these exceptions – including how to count FTE’s to qualify as a “small” provider – see Chapter 24 of the Medicare Claims Processing Manual, Section 90 (the relevant information starts on page 81).

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Happy billing!

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