Monday, August 9, 2010


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.
                      o Dates of service must match
                      o Procedure codes must match
                      o 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 claim 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. In order for MA to pay for co-insurance and deductibles, the CMS-1500 and the Medicare EOMB must be submitted. Claims should be sent to the original claims address.

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