An advance payment is a conditional partial payment, which requires repayment, and may be issued
when the conditions described in CMS regulations at 42 CFR 421.214 are met. An advance payment may
be made if all of the following conditions are met:
• The carrier is unable to process the claim timely.
• CMS determines that the prompt payment interest provision specified in section 1842(c) of the Act is
insufficient to make a claimant whole.
• CMS approves, in writing to the carrier, the making of an advance payment by the carrier.
Advance payments are not made to any supplier that meets any of the following conditions:
• Is delinquent in repaying a Medicare overpayment.
• Has been advised of being under active medical review or program integrity investigation.
• Has not submitted any claims.
• Has not accepted claims’ assignments within the most recent 180-day period preceding
the system malfunction.
If the provider meets the above criteria, please fill out the following forms.