Medicare (Original / Part A & B)
Also covers / subsidiaries: CMS, Medicare Fee-for-Service, MAC
Core Payer & Clearinghouse Profile
Electronic Payer ID
10125
Use your regional MAC's payer ID (Novitas, Palmetto GBA, NGS, WPS, First Coast, Noridian, CGS).
Timely Filing Limit (TFL)
1 calendar year from the date of service (statutory)
Appeal Window
120 days from the remittance for a redetermination (first level)
Clearinghouse Gateway
Submit through your MAC / clearinghouse
Provider Services
Varies — confirm via portal / clearinghouse
Claims Fax
Varies — confirm via portal / clearinghouse
Claims Address
Varies — confirm via portal / clearinghouse
Provider Portal
https://www.cms.gov
Claims route to the Medicare Administrative Contractor (MAC) for your state. The 1-year timely-filing limit is set by federal law.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for Medicare (Original / Part A & B).
Associated Clearinghouse Payer IDs
National clearinghouse networks maintain dedicated routing IDs for specific transaction lines or subsidiaries under Medicare (Original / Part A & B).
| Clearinghouse Name | Electronic Payer ID | Status | Enrollment | Supported Services |
|---|---|---|---|---|
| Edic | J1289 | Non-Par | None | Workers Comp |
| Edic | WB021 | Non-Par | None | Workers Comp |
| Medica | 10125 | Non-Par | None | 837P837I270/271276/277Dental |
| Medica | 94265 | Non-Par | Required | 837P837I835 ERA |
| Medicare | 00431 | Non-Par | None | 837P837I270/271Dental |
Resolution Tools for Medicare (Original / Part A & B) Claims
Values vary by plan, line of business, and provider agreement. Confirm in the payer portal or with your clearinghouse gateway before submitting electronic claims. Last verified 2026-06-24.
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