CMS Pub. 100-04, ch. 1, § 50.1.7

For those billing A/B MACs (B) and DME MACs, a claim does not have to be on a form

but may be any writing submitted by or on behalf of a claimant, which indicates a desire

to claim payment from the Medicare program in connection with medical services of a

specified nature furnished to an identified enrollee. It is not necessary that this

submission be recorded on a CMS claim form, that the services be itemized or that the

information submitted be complete (e.g., a note from the enrollee’s spouse, or a bill for

ancillary services in a nonparticipating hospital, could count as a claim for payment).

The writing must contain sufficient identifying information about the enrollee to permit

the obtaining of any missing information through routine methods, e.g., file check,

microfilm reference, mail or telephone contact based on an address or telephone number

in file. Where the writing is not submitted on a claims form, there must be enough

information about the nature of the medical or other health service to enable the

contractor with claims processing jurisdiction to determine that the service was

apparently furnished by a physician or supplier.

The definition of a part B claim for purposes of timely filing is any writing submitted by

or on behalf of a claimant, which indicates a desire to claim payment from the Medicare

program for medical services of a specified nature to an identified enrollee. For example,

a note from the enrollee’s spouse or a bill for ancillary services in a nonparticipating

hospital could constitute a claim for payment.

If such a claim is mailed or delivered to SSA, CMS or to any A/B MAC (A or B) within

the time limit, the claim is filed timely provided the necessary claims information (e.g.,

Form CMS-1490S and itemized bill in the case of an enrollee-filed claim) is submitted

within the time limit or, if later, within six months after the end of the month in which the

claimant is advised to furnish it, e.g., if the notice is provided February 2, the claim must

be filed by close of business August 31. See Statement of Intent instructions in §70.7.

Note that electronic claims must be in the appropriate HIPAA standard format. Refer to

section 2 of this chapter as well as chapters 24 and 25 for more information.