Overpayments

Credit Balance Reporting

Table of Contents

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What is a Credit Balance?

Generally, when a provider receives an improper or excess payment for a claim, it is reflected in the provider’s accounting records as a “credit.” The provider is responsible for identifying and repaying all monies from these credits to the Medicare Program.

Credit balance reporting is used to certify whether you have any outstanding monies owed to the Medicare Program. As of 12/1/2024, Medicare Part A providers must submit credit balance reports to Medicare as soon as credit(s) are identified, regardless of the date of service. Prior to this date, Medicare Part A providers submitted credit balance reports on a quarterly basis.

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What Should I Do When I Have a Credit Balance?

If you have credit balance(s) to report, complete all 15 columns of the Credit Balance Report (CMS-838) detail page and submit it to Medicare as soon as the credits are identified. 

Please note the only credits to be reported on the 838 detail page are those:

  • that would be submitted to Medicare on a CMS UB-04 form. DME and claim information submitted on CMS-1500 forms are not reported on a CMS-838 Detail page.
  • where the amount due to Medicare has not been recouped through the claim adjustment process. 

You have several options available to submit your Credit Balance Report:

  • Through our secure internet portal, NGSConnex (preferred method)
  • Via U.S. Mail
  • By Fax

Mailing addresses and fax numbers vary by jurisdiction/state – scroll down to “ORU and Credit Balance Reports” on our Contact Information page to locate the appropriate information for your provider.

To submit your Credit Balance Report in NGSConnex:

  • Either manually enter the CMS-838 details or upload your completed CMS-838 Excel file saved as a CSV file extension.
  • If you are not yet a registered NGSConnex user for the provider, follow the NGSConnex User Guide instructions to register now so you are ready to use NGSConnex when the next credit is identified.
  • If you are already a registered NGSConnex user, follow the NGSConnex User Guide instructions to complete the Certification page and submit the accompanying Credit Balance Report details.

Benefits of using NGSConnex to submit your credit balance reports:

  • You won’t need to fax or mail anything.
  • Validation edits ensure all required fields on the Certification Page are complete.
  • Immediate confirmation that your report has been submitted.

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Additional Tips for a Successful Credit Balance Report Submission 

  1. Submit your credit balance reports as soon as the credits are identified, especially if you are faxing your reports. Due to the high volume of submissions, providers may receive a busy signal when faxing their reports during peak submission times.
  2. Do not submit CDs or diskettes with a CMS-838 detail page.
  3. When faxing 838 detail page(s), select a font size no less than 8 point and include your email address on your fax cover sheet.
  4. Avoid handwriting information on the 838 detail page. Submitting claim information using an Excel spreadsheet is acceptable as long as the format is identical to the CMS-838 detail page.
  5. Credits being reported on the 838 detail page due to Medicare paying incorrectly as the primary insurance should include the complete mailing address of the other insurance carrier along with the company name.

Revised 1/27/2025