Claim Line Maximums to Prevent Claim Line Splitting During Processing - JA DME
Claim Line Maximums to Prevent Claim Line Splitting During Processing
When submitting claims there are specific guidelines regarding claim line maximums. Following these guidelines helps prevent claim lines from being split into multiple submissions, ensuring that all claim lines are processed together under the same date of service (DOS).
Key Guidelines
Claim Line Totals
Once you have entered the maximum claim lines based on the submission format, be sure to include a total amount for those claim lines at the bottom of the claim form. This should be indicated in Item 28 on the CMS-1500 form or the equivalent field in the electronic format. Importantly, avoid using the word "continued" on the claim.
- Electronic Claims: Maximum Claim Lines = 13 Lines per Claim Submission
For electronic submissions, there is a strict limit of 13 claim lines per claim submission. Exceeding this limit may result in the automatic splitting of the claim lines during processing.
- Hard Copy 1500 Claim Form: Maximum Claim Lines = 6 Lines per Claim Submission
When submitting claims using the hard copy 1500 form, the maximum number of claim lines is limited to 6.
If the number of claim lines exceeds the maximum allowed and totals are not provided, the claim lines may split during processing. This can lead to necessary items being separated across multiple claims, which could result in denials.
What to Do If Claims Are Split
Even with adherence to these guidelines, claims may occasionally be split into multiple submissions during processing. If this happens, you may need to appeal the claim to resolve the issue and ensure proper processing.
