Advance Payment is the contractor’s conditional partial payment to a provider on a Medicare Part B claim the contractor is unable to process within the dictated time limits (i.e., claim system problems, etc.).
Mail your request to:
Novitas Solutions
Debt Recovery - Part B
Advance Payment Request
PO Box 3063
Mechanicsburg, PA 17055-1806
Fax: 717-526-3483
When an advance payment is requested, the contractor will review the reason for the request. The request must include (42 CFR §421.214):
A written request from the provider with detailed information supporting the reason for delayed payment is due to the contractor’s processing error.
The amount the provider is requesting for payment.
Novitas Solutions must confirm that the provider:
Is not under Medical Review or Program Integrity Investigation;
Has no outstanding Medicare overpayments;
Has not been delinquent in repaying outstanding overpayments involving Medicare claims;
Accepts assignment on all claims submitted within the past 180 days preceding the request or system malfunction;
Agrees to the offset of all future claim payment(s); and
Maintains assignment on claims submitted during the processing issue equal to or greater than the rate of the 180-day period prior to the request.
If the above is valid, the contractor can proceed processing the advance payment request. All Advance Payments are calculated at no more than 80% of the historical assigned claim payment data. This historical data represents a 90-day claim payment trend within the previous 180 days.
A letter is sent the Center for Medicare & Medicaid Services (CMS) Regional Office to request final approval of the advance payment.
Upon receiving CMS’ response of concurrence or disapproval, the provider is notified immediately.
Back to Overpayment page
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