How to Filing Form CMS-1500 - Tips to submit claim

Filing Form CMS-1500

Medicare Part B physicians may use the red-printed Form CMS-1500 to file various health insurance claims to private insurers and government programs. However, payment for paper claims takes substantially longer than payment for electronically submitted claims. Generally, electronic claims can be paid 14 days after submission, as opposed to paper claims that process in about four weeks. 

How Paper Claim Submission 

Works When filing paper claims, physicians must type or machine-print all mandated claim fields on the red-printed Form CMS-1500 and mail it to the local carrier. Some carriers may be able to accept a black and white copy of Form CMS-1500. Other carriers may not accept black and white copies of the form if they are using Optical Character Recognition (OCR) equipment to process the form.

Optical Character Recognition 

Carriers that process claims with OCR, use an automated scanning process similar to scanners that read price labels in grocery stores. OCR claims processing is faster and more accurate than systems requiring manual input. However, to work properly, OCR must accurately read and interpret the characters entered in each field. It reads only typed or machine-printed data. Only an original, red and white Form CMS-1500 may be submitted. Black and white photocopies cannot be machine read and will be returned. 

After claims information is scanned, it is transmitted to the claims processing system, where it is validated. 

To ensure accurate, quick claim processing, the following guidelines must be followed: 

*Do not staple, clip, or tape anything to Form CMS-1500

*Place all necessary documentation in the envelope with Form CMS-1500 

* Put the patient ’ s name and Medicare number on each piece of documentation submitted 

* Use dark ink 

* Use only upper-case (CAPITAL) letters 

* Use 10 or 12 pitch (pica) characters and standard dot matrix fonts 

* Do not mix character fonts on the same form 

* Do not use italics or script 

* Avoid using old or worn print bands or ribbons

* Do not use dollar signs, decimals, or punctuation 

* Enter all information on the same horizontal plane within the designated field 

* Do not print, hand-write, or stamp any extraneous data on the form 

* Use only lift-off correction tape to make corrections 

* Ensure data is in the appropriate field and does not overlap into other fields 

* Remove pin-fed edges at side perforations 

* Use only an original red-ink-on-white-paper Form CMS-1500

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