Article Detail - JA DME

When submitting claims, it’s essential to follow specific guidelines regarding claim line maximums. Adhering to these guidelines helps prevent claim lines from being split into multiple claim submissions, ensuring that all claim lines are processed together under the same date of service (DOS).

Key Guidelines

Claim Line Totals

After entering 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 claim lines during processing when the claim is not totaled at the bottom of the claim form.

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 this maximum and totals are not provided, the claim lines may split during processing. This could lead to necessary items being separated across multiple claims, resulting in delays or denials.

What to Do If Claims Are Split

Even with strict adherence to these guidelines, there may be instances where claims are split into multiple claim submissions during processing. If this occurs, you may need to appeal the claim to resolve the issue and ensure proper processing.