CMS-1500 KIDNEY DISEASE PROGRAM BILLING INSTRUCTIONS

CMS-1500 KIDNEY DISEASE PROGRAM BILLING INSTRUCTIONS

INTRODUCTION

These billing instructions have been prepared to provide proper procedures and instructions for
the Kidney Disease Program providers who use the CMS-1500 (08-05) form.

BILLING INFORMATION

Providers must bill on the CMS-1500 claim form. Claims can be submitted in any quantity and
at any time within the filing limitation.

Filing Statutes: Claims must be received within 6 months of the date of service. The following
statutes are in addition to the initial claim submission.

• 3 months from the date of any intermediary payment, i.e., Medicare, other third party insurance (Must include copy of EOB.)

PROCEDURES FOR SUBMITTING HARDCOPY MEDICARE CLAIMS

Billing a CMS-1500 with a Medicare EOMB:

On the Medicare EOMB, each individual claim is generally designated by two horizontal lines. Therefore, you should complete one CMS-1500 form per set of horizontal lines.
• When billing Medical Assistance, the information on the CMS-1500 must be identical to the information that is between the two horizontal lines on the Medicare EOMB.
o Dates of service must match
o Procedure codes must match
o Amount(s) on line #24F of the CMS-1500 must match the “amount billed” on the EOMB.

• Each CMS-1500 claim must be totaled with accompanying EOB attached.

• When submitting your Medicare claims for payment, the writing should be legible. In addition, when attaching a copy of the Medicare EOMB make sure it is clear and that the entire EOMB, including the information on the top and the glossary is included on the copy. In order for KDP to pay for co-insurance and deductibles, the CMS-1500 and the Medicare EOMB must be submitted.

Claims should be sent to the original claims address:
Kidney Disease Program
201 W. Preston Street, SS3
Baltimore, MD 21203

The Program will not accept computer-generated reports from the provider’s office as proof of timely filing. The only documentation that will be accepted is a remittance advice, Medicare/Third-party EOB, and/or a returned date stamped claim from the Program.

All claims should be mailed to the following address:

Department of Health and Mental Hygiene
Kidney Disease Program
201 W. Preston Street, Room SS3
Baltimore, MD 21201