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| Reminder: Administrative Simplification Compliance Act (ASCA) Enforcement As a reminder to all suppliers the Administrative Simplification Compliance Act (ASCA) includes a provision that states, effective October 16, 2003; Medicare may not pay claims submitted on paper with certain exceptions. Some exceptions listed in the Final Rule are: Claims submitted by small providers (a provider/supplier with fewer than 10 full-time employees)Dental claimsClaims submitted by a participant in a Medicare demonstration projectRoster claims mass immunizationsClaims sent to Medicare when more than one other insurer was liable for payment prior to Medicare (Tertiary claims)Home Oxygen Therapy claims with an Oxygen CMN form 484.03 when Question 1 has a PO2 value equal to 56-59 or an Oxygen Saturation greater than 88%, and the responses to Questions 7-9 are all "No." (Note: On Oxygen CMN form 484.02, the Questions are 8-10.)Claims submitted by providers that rarely treat Medicare patients and submit fewer than 10 claims a monthClaims submitted by beneficiariesClaims from providers that only furnish services outside the United StatesClaims from providers that experience a disruption in electricity and/or communications that is outside of their control and is expected to last longer than two days.Providers that can establish that some other unusual circumstance exists that precludes the submission of claims electronically. You are considered in violation of the ASCA provisions if you do not meet one of the exceptions listed above and you continue to submit paper claims. Being in violation of the ASCA provisions, subjects you to the ASCA enforcement laws established in the Centers for Medicare & Medicaid Services Change Request 3440. To get more information on the ASCA provision, please visit the ASCA section of our Web site by: Going to www.NGSMedicare.comSelect your Business Type and Region , once on the Provider Specific Portal Home Page, select Claims , then Administrative Simplification Compliance Act should be displayed. |
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