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Credit Balances

CMS requires Credit Balance Reports be submitted within 30 days after the end of the quarter. If the reports are not received by the due date, suspension of payments may result. Please see the quarter ending and due dates listed below.

Quarter Ending Due Date
March 31 April 30
June 30 Jul 30
September 30 October 30
December 31 January 30

The certification form must be completed, signed, and submitted whether or not there are credit balances to report. A certification form must be completed for each provider number. The CMS 838 form must be completed for all Credit Balances reported. Please include the provider name, provider number, reporting quarter, contact person, and phone number, reporting quarter, contact person and phone number. When completing the CMS 838 form, please ensure all columns are completed.

Please note that all Credit Balances must be accompanied by a UB04. If a UB04 is not attached a demand for repayment of the credit balance will be issued.

Providers with extremely low Medicare utilization do not have to submit a CMS-838. A low utilization provider is defined as a facility that files a low utilization Medicare cost report, or files less than 25 Medicare claims per year. (See CMS Internet-Only Manual (IOM) Publication 100-06, Chapter 12.)

Do not hold your adjustments for the Credit Balance Report. Your adjustments should be submitted to our office as credit balances are recognized.

To download the Certification form, the CMS 838 form and instructions for completing the report, please use the links below.

Mailing Addresses for Credit Balance Reports

All Credit Balance reports must be mailed. WPS Medicare will not accept faxed reports.

Mailing address for Credit Balance reports

J5 MAC A Addresses
WPS Medicare Part A
Medicare Secondary Payer
P.O. Box 7665
Madison, WI 53707-7665
WPS Medicare Part A
Medicare Secondary Payer
P.O. Box 7576
Madison, WI 53707-7576
WPS Medicare Part A
Medicare Secondary Payer
P.O. Box 8890
Madison, WI 53708-8890
WPS Medicare Part A
Medicare Secondary Payer
P.O. Box 8799
Madison, WI 53708-8799

J5 National A Address

WPS Medicare Part A
Medicare Secondary Payer
P.O. Box 7861
Madison, WI 53707-7861

J5 and J5 National A Physical Address

Medicare J5 and J5 National Part A Medicare Secondary Payer
1717 West Broadway
Madison, WI 53713

Please ensure the correct forms (CMS Certification page and 838 report) are used and completed in their entirety. To access the most current versions of these forms, please use the links above.

We do send suspension notification letters 5 days after the due date if the reports have not been received. You will have 15 days from the date of the letter to submit your report. If the report is still not received suspension will occur at 100%. Once your report is received, the suspension will be removed and you will receive payment on your normal schedule.

Please contact us at (866) 734-1521 if you have any questions.