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Medicare Billing: CMS-1500 & 837P

Other Exceptions

Unusual circumstances also can affect electronic claim submission, including:

  1. Dental claims
  2. Disruption in electricity, phone, or communication services lasting more than 2 business days
  3. Claims from a larger group practice or supplier that rarely treats Medicare patients, submitting less than 10 claims a month and not more than 120 claims per year

If a self-assessment indicates that any of these circumstances applies to you, you’re automatically waived from the electronic claim submission requirement. You can submit the CMS-1500 paper claim for the claim type shown or the time period when an unusual situation occurs.

Some of these situations are temporary or apply only to some claims. When the temporary situation expires or when billing other types of claims, you must submit your claims electronically in the HIPAA and Administrative Simplification standard format.