PROCEDURES FOR SUBMITTING HARDCOPY MEDICARE CLAIMS Billing a CMS-1500 with a Medicare EOMB: On the Medicare EOMB, is generally designated by two horizontal lines. each individual claim Therefore, you should complete CMS-1500 form per set of horizontal lines. one When billing Medical Assistance, the information on the CMS-1500 must be identical to the information that is on the Medicare EOMB. between the two horizontal lines Dates of service match must Procedure codes match must Amount(s) on line #24F of the CMS-1500 match the billed” on must “amount the EOMB. Claims that have then six lines, write in Block #28 of each more “con’t” CMS-1500 and total all the lines on the CMS-1500 claim. last 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. Write in bold letters on each claim. In order for MA to EOMB” “Medicare make the necessary payments, the CMS-1500 and the Medicare EOMB must be submitted. Claims should be sent to the original claims address: Medical Assistance
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. Dates of service must match Procedure codes must match Amount(s) on line #24F of the CMS-1500 must match the “amount billed” on the EOMB. Claims that have more then six lines, write “con’t” in Block #28 of each CMS-1500 and total all the lines on the last CMS-1500 claim. 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. Write in bold letters “Medicare EOMB” on each claim. In order for MA to make the necessary payments, the CMS-1500 and the Medicare EOMB must be submitted. Claims should be sent to the original claims address: Medical Assistance
CMS1500%20Billing%20Instructions.docx