CMS-1500 Claim Form Guidelines and Tips - JA DME

All paper claims must be submitted on the Revised Form CMS-1500 (02/12). This form is the only version accepted by Medicare.

Responsibility for Accurate Claims

The supplier is ultimately responsible for the accuracy of claims filed for his/her services. We recommend the supplier's office set a policy to ensure all necessary information is included on the initial claim submission and the information is correct. Suppliers may refer to the CMS-1500 instructions for guidance on completing the claim form.

Guidelines for Filing Paper Claims

Failure to follow these guidelines could cause a delay in processing, denial of the claim, or affect payment accuracy.

The Administrative Simplification Compliance Act (ASCA) mandates the submission of electronic claims to Medicare unless a supplier meets certain "exceptions" described within the law. View exceptions on the Administrative Simplification Compliance Act Self Assessment webpage.

CMS-1500 Claim Form Instructions

Complete instructions for the CMS-1500 claim form are provided in the CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 26.

Tips for Submitting Clean Paper Claims

Noridian uses optical character recognition (OCR) to process paper CMS-1500 claim forms. OCR is a means of inputting text into a computer. It involves scanning a paper document to create a digital image of the text and then using software to store knowledge about that digital image. With OCR, it is very important suppliers follow proper paper claim submission guidelines.

Font and Printing

• Use Courier New font for computer-generated claims. Do not print in italics, bold or script. Do not mix fonts.
• Use Pica 10 or 12-point typeface for claims typed on a typewriter.
• Do not type in italics or script.
• Use upper case letters for all claim data.
• Ensure none of the characters touch.
• Ensure no lines from the printer cartridge are anywhere on the claim.
• Do not use special characters, (dollar signs, decimals, dashes, asterisk, or backslashes) unless otherwise specified.
• Use an ink jet or laser printer to complete the CMS-1500 claim form. Because claims submitted with dot matrix printers have breaks in the letters and numbers, OCR equipment is unable to properly read these claims. Suppliers using dot matrix printers risk slow or incorrect processing of their claims.

Ink Color

The OCR equipment is sensitive to ink color. Follow these guidelines on ink color:

• Submit the scannable, red-ink version of the CMS-1500 claim form.
• Do not use red ink to complete a CMS-1500 claim form. OCR scanners "drop out" any red that is on the paper.
• Use true black ink. Do not use any other color ink such as blue, purple, or red.

Avoid using old or worn ink cartridges, toner cartridges, or printer ribbons.

Alignment

To process a claim correctly, proper alignment of the CMS-1500 form information is necessary. The OCR equipment may not read information that is not aligned properly, resulting in unnecessary denials or incorrect payment. To properly align data on the claim form, do the following:

• Center information vertically within the confines of each box on the CMS-1500 claim form.
• Align all information on the same horizontal plane.
• Do not include more than six line items on a CMS-1500 claim form.
• Do not squeeze two lines of information on one line.

Handwritten Claims

Handwritten claims are difficult to read; therefore, they take longer to process. The OCR equipment may misread the information, resulting in the entry of invalid information for the claim. To ensure timely and accurate processing of claims, Noridian recommends claims be typed, not handwritten.

Preprogrammed, Preprinted Information

Do not use preprinted or preprogrammed information on the CMS-1500 claim form. An example of preprinted or preprogrammed information is a pointer of "A" in Item 24e on all six detail lines but only submitting one claim detail line.

The areas of most concern for preprinted or preprogrammed information are Item 24 and the bottom of the claim form. Preprinted information in these areas cause the OCR equipment to read information not intended for the specific field, resulting in an Education Status letter.

Ordering CMS-1500 Claim Forms

In order to purchase claim forms, contact the U.S. Government Printing Office at 1-866-512-1800, local printing companies, and/or office supply stores. Each of these vendors sells the CMS-1500 claim form in its various configurations (single part, multi-part, continuous feed, laser, etc).

Electronic Claims

Electronic Data Interchange (EDI) provides the ability to quickly and efficiently exchange healthcare information in a safe, secure, and cost-effective way. Electronic claims are transmitted to the Common Electronic Data Interchange (CEDI) contractor. After the electronic claim has been accepted by the CEDI, the claim is then transferred to the appropriate DME MAC for processing based on the permanent address listed with Social Security on the electronic claim.

To learn more about EDI, contact CEDI.