US · guidance
CMS Pub. 100-04, ch. 24, § 20.4
Administrative Simplification and Compliance Act (ASCA)
The Administrative Simplification Compliance Act (ASCA) prohibits payment of
services or supplies that a provider did not bill to Medicare electronically. “Providers” 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 in the ASCA self assessment page in this
section of the CMS web site. In some cases, providers are required to submit a written
request to their Medicare contractor to receive permission to submit some or all of their
claims on paper.
A/B MACs and DME MACs are required to contact providers that appear to be
submitting high numbers of paper claims to verify that those providers meet one or more
of the exception criteria for continued submission of their claims on paper.
See Section 90 below for further details regarding ASCA requirements, or access
www.cms.gov/ElectronicBillingEDITrans for further information on ASCA enforcement
reviews, the self assessment, and the waiver application.
History
(Rev. 2803, Issued: 10-28-13, Effective: 09-17-13, Implementation: 09-17-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
dadc8d43b79cb89771fa36b57bbe1ab45870099d2c32480eab50946985b92200
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