Proper Medicare Part B Claim Submissions – Completion and Regulation for the CMS-1500 Paper Claim Form Due to the Change Healthcare Security Incident

Health care professionals and suppliers play a vital role in protecting the integrity of the Medicare Program by submitting accurate claims, maintaining current knowledge of Medicare billing policies and ensuring all documentation required to support the medical need for the service rendered is submitted.

This communication is a supplement to the article posted on 3/7/2024 Submitting Paper Claim Forms to National Government Services Due to the Change Healthcare Security Incident. 

We have multiple instructions on our website containing material on completion of Medicare paper claims forms at CMS-1500 Claim Form. You can locate valuable information on our website that will assist you in the submission of your paper claims.

Listed below are links that will help in providing documentation around CMS-1500 Claim Form submission Instructions:

• CMS-1500 Claim Form Completion Instructions
• General Information
• Claim Filing Instructions for Paper and Electronic Submission
• Regulations on Charging for Claim Form Completion
• Optical Character Recognition System
• Missing, Incomplete, Insufficient or Invalid Claim Information
• Health Insurance Claim CMS-1500 Form (02/12)
• Patient and Insured Information
• Medicare Part B CMS-1500 Crosswalk for 5010 Electronic Claims
• Medicare Billing Fact Sheet for Electronic (837P) and Paper (Form CMS-1500) Claims
• Handwriting on Claims Submitted to Medicare
• Date of Service on CMS-1500 Billing
• Unprocessable Claim Rejections and Corrections
• MLN® Fact Sheet: Medicare Billing: 837P and Form CMS-1500 Fact Sheet

When submitting paper claims the following requirements must also be met:

• All paper claims are required to be submitted using an original red/white CMS-1500 (02/12) form.
  • Black and white copies will be returned as unprocessable.
  • Submission of the CMS-1500 (02/12) claim form should either be typed or computer printed forms. 
• The form is designed for typewritten characters 10 or 12 pitch (pica).
• Use Courier New font for computer-generated claims. Character fonts may not be mixed on the same form. Ensure none of the characters touch.
• Italics, bold or script may not be used. Do not use special characters (dollar signs, decimals, dashes, asterisk, backslashes, punctuation).
• Use upper case (CAPITAL) letters for all alpha characters.
• Enter all information on the same horizontal plane and within designated fields. 
• 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. Old or worn print bands or ribbons should be avoided. Ensure no lines from the printer cartridge are anywhere on the claim.
• No Handwriting
  • Handwritten forms can cause delays and errors in processing and slow down time for reimbursement.
  • Corrections may not be handwritten in any data field. Pin feed edges are to be removed evenly at side perforations.
  • Extraneous data may not be printed, handwritten, or stamped on the form.

Note: If you are impacted by the Change Health cyber attack, you must still complete an ASCA form to submit paper claims; however, you do not need to complete all fields of the form. You may simply indicate that you are impacted by the Change Health cyber attack and complete your provider information. We will process your application expeditiously. You may find the ASCA form here:  NGS ASCA Waiver Form. 

Posted 3/12/2024