ONLINE 837P and Form CMS-1500

5. The timely filing period for both paper and electronic Medicare claims is ____ months after the From date of service on the claim.

12

7. The ____ establishes a nationally standard contract between the Centers for Medicare & Medicaid Services (CMS) and other health insurance organizations that defines the criteria for transmitting enrollee eligibility data and Medicare adjudicated claim data.

A. Coordination of Benefits Agreement (COBA) Program

6. Each level of the appeals process must be completed for each claim prior to proceeding to the next level of appeal. Which of the following is the last level of appeal?

C. Federal Court Review

1. A health care professional or supplier must obtain Medicare pre-approval to submit paper claims in all of these situations except:

D. Disruption in electricity or phone/communication services expected to last more than two business days

10. A health care professional or supplier may appeal claims that are returned as unprocessable for incomplete or invalid information.

False

2. When submitting the 837P or Form CMS-1500, the place of service is always required on the claim.

True

3. The American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12N 837 Professional (837P) Version 5010A1 is the electronic claim format of the Form CMS-1500.

True

4. The CMS-1500 was developed though a collaborative effort led by the National Uniform Claim Committee (NUCC) in consultation with CMS.

True

8. Health care professionals or suppliers are to self-assess to determine if they meet the Administrative Simplification Compliance Act (ASCA) exceptions to submit a paper claim.

True

9. Each health care professional or supplier must complete an Electronic Data Interchange (EDI) Enrollment Form prior to submitting electronic transactions either directly with Medicare or through a billing service or clearinghouse.

True