Billing MSP via CMS-1500 Paper Form - JF Part B

When Medicare is a beneficiary's secondary payer (MSP), providers submitting claims via paper are required to include the following with each CMS-1500 form.

• Copy of primary payer's Explanation of Benefits (EOB)
• Explanation of how claim was processed
• Patient-specific identifying information
• Date of service for each submitted CMS-1500 form

Claims submitted without an attached EOB will be denied as unprocessable and must be resubmitted.

The CMS Internet Only Manual (IOM), Publication 100-05, Medicare Secondary Payer Manual, Chapter 3, Section 60 states, "In addition, each claim must have an EOB from the primary payer attached that identifies the amount allowed, paid, or denied by the primary payer."