Administrative Simplification Compliance Act Waiver Application

Administrative Simplification Compliance Act Waiver Application

The Administrative Simplification Compliance Act (ASCA) prohibits payment of services or supplies that a provider did not bill to Medicare electronically. “Provider” 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 elsewhere in this section of the CMS web site.

There are also some situations when this electronic billing requirement could be waived for some or all claims, but a provider must obtain Medicare pre-approval to submit paper claims in these situations:

•Any situation where a provider can demonstrate that the applicable adopted HIPAA claim standard does not permit submission of a particular type of claim electronically;
•Disability of all members of a provider's staff prevents use of a computer for electronic submission of claims; and
•Other rare situations that cannot be anticipated by CMS where a provider can establish that due to conditions outside of their control, it would be against equity and good conscience for CMS to enforce this requirement.

A request for this type of waiver must be sent by letter to the Medicare Administrative Contractor (MAC) to which a provider submits claims.

See Sections 90 - 90.7 of Chapter 24 of the Medicare Claims Processing Manual (Pub.100-04) for further information on ASCA electronic billing requirements and Enforcement Reviews of providers.

Page Last Modified:
09/06/2023 04:51 PM