Electronic and Paper Claims

3.4.1 - Electronic and Paper Claims (Rev. 721; Issued: 06-09-17; Effective: 07-11-17; Implementation: 07-11-17) This section applies to MACs. The Administrative Simplification Compliance Act (ASCA, Section 3 of Pub. L, 107- 105, 42 CFR 424.32) requires that all Medicare claims be submitted electronically using the ASC X12 837 institutional or professional claim formats with few exceptions. MACs shall not require providers to submit paper claims when they are targeted for prepayment medical record review. The MACs shall allow providers that qualify for an ASCA mandatory electronic billing exception to submit paper claims when they are targeted for prepayment review (See IOM Pub.100-04, chapter 24, §90 for exceptions).