Administrative Simplification and Compliance Act (ASCA)

20.4 - Administrative Simplification and Compliance Act (ASCA) (Rev. 2803, Issued: 10-28-13, Effective: 09-17-13, Implementation: 09-17-13) The Administrative Simplification Compliance Act (ASCA) prohibits payment of services or supplies that a provider did not bill to Medicare electronically. “Providers” is used in a generic sense here and refers equally to physicians, suppliers, and other health care providers. Providers are required to self-assess to determine whether they meet certain permitted exceptions to this electronic billing requirement. ASCA self-assessable situations are described in the ASCA self assessment page in this section of the CMS web site. In some cases, providers are required to submit a written request to their Medicare contractor to receive permission to submit some or all of their claims on paper. A/B MACs and DME MACs are required to contact providers that appear to be submitting high numbers of paper claims to verify that those providers meet one or more of the exception criteria for continued submission of their claims on paper. See Section 90 below for further details regarding ASCA requirements, or access www.cms.gov/ElectronicBillingEDITrans for further information on ASCA enforcement reviews, the self assessment, and the waiver application.