Tuesday, July 6, 2010

INSTRUCTIONS FOR COMPLETING THE CMS 1500 MEDICARE ATTACHMENT

CMS 1500 Medicare Attachment Summary

Please use this form in lieu of attaching the Medicare Explanation of Benefits (EOB) when billing. All the fields on this form must be completed in order to process your claim in a timely manner. If any of the fields are not completed, the claim and attachements will be returned to you for completion.

The attachment MUST NOT be used when submitting claims electronically.


INSTRUCTIONS FOR COMPLETING THE CMS 1500 MEDICARE ATTACHMENT


Please complete and attach the Medicare Attachment, instead of attaching a copy of the Medicare EOB, to the CMS 1500. This attachement form will assist providers in submitting claims successfully for Medicare deductible and/or co-insurance. There are 6 lines provided on this form that correlate to the 6 lcim lines on the CMS1500. When submitting claims on the CMS 1500 for Medicare deductible and/or co -insurance this Medicare attachment must be completed and submitted with the CMS 1500 claim form.

Please DO NOT staple or paper clip this form to the claims.

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