What recent changes in legislation require electronic submission of claims? what are the benefits of submitting claims electronically? which provider types are exempt from submitting claims electronically and why?

1. What recent changes in legislation require electronic submission of claims?

- The Administrative Simplification Compliance Act (ASCA) under section 3 of PL-107-105 requires the initial submission of claims for reimbursement under Medicare to be electronic effective on October 16, 2003.

2. What are the benefits of submitting claims electronically?

- Electronic submission of claims means quicker claims submission and faster reimbursement. It also eliminates lengthy process of paper claims and submission. Lost claims and consequent paper work is also eliminated. Lastly, the simplified process of electronic submission of claims lowers the cost of manpower due to reduced clerical time and processing.

3. Which provider types are exempt from submitting claims electronically and why?

- Providers that furnish services outside of the United States, to Medicare managed health plans, health plans other than medicare, dentists, a participant in the Medicare demonstration project, provider that gives mass immunization, provider that submits claims with more than one payer, and small providers with less than 25 full time employees are not covered by this requirement. This is because these types of providers may not qualify yet for EDI enrollment and also, may not satisfy CMS requirements due to the nature of their business.

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