ASCA Waiver Application

ASCA Waiver Application Guidelines For Providers

ASCA Waiver Application guidelines describe 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;
  • 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.

What is the Administrative Simplification Compliance Act (ASCA)?  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.


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