Monday, September 27, 2010

Specifications for Submitting CMS–1500 Claim Forms

Font
Using the proper font will greatly help with alignment of data submitted on paper claims. Print must be Pica
10 or 12-point typeface, and only black printer ink should be used. The type should be Courier, letter quality,
and is best submitted in all upper case letters. None of the characters should be touching, and there should
not be lines from the printer cartridge anywhere on the claim. Fonts should not be mixed, and they should
not be in italics or script. Special characters should not be used, i.e., dollar signs, decimals, or dashes.

Ink Color

Due to the use of Optical Character Recognition equipment, no red ink should be used to complete a CMS-
1500 claim form. This equipment will “drop out” any red that is on the paper. The only ink that is picked up
correctly is true black ink. Any variation of blue, purple, or red ink should not be used. Avoid old or worn
printer ribbons.

Another common error is claims that are submitted that have been printed without red ink or the
appropriate type of red ink. The CMS–1500 claim form must be submitted using the scannable, red ink
version. These red ink versions can be purchased from a printer company, such as the U.S. Government
Printing Office by calling (202) 512-1800. You can also contact the U.S. Government Printing office at the
following address:

Asst. Supt., Dept. of Acct., Rep. Div.
USGPO Room C-830
Washington, DC 20401

Alignment
Proper alignment of the CMS–1500 form information is necessary for the claim to be processed correctly.
Information should be centered horizontally and vertically within the confines of each item box on the 1500
form. All information should be aligned on the same horizontal plane. The OCR equipment may not read
information that is not centered properly causing unnecessary denials or incorrect payment. Only six line
items should be entered per claim; do not squeeze two lines of information on one line.



Dot Matrix Printers
Providers who use dot matrix printers run the risk of their claims being processed slower and possibly
incorrectly. OCR equipment is unable to read claims submitted with dot matrix printers as there are breaks
in the letters or numbers. NAS recommends using an ink jet or laser printer to complete the CMS–1500 claim
form.

Handwritten Claims

Handwritten claims are not only hard to read, they can also take longer to process. To ensure claims will be
processed in a timely manner, NAS recommends that claims are typed instead of handwritten or partially
handwritten. Handwritten claims could cause unnecessary delays in processing and could cause invalid
information to be entered.

Medicare Part B Basic Billing Manual states: “Claims should not be handwritten, upper case letters only must
be used, print must be Pica 10 or 12 point type face, and printer ink should be black only.”

Stuffing Envelopes

NAS receives many overstuffed envelopes. This causes the material to become damaged, partially received, or lost altogether before it arrives in our office.

NAS recommends including no more than four sheets of paper per regular #10 envelope. When submitting
more than four pages, a larger “flat” envelope that measures roughly 9” x 12” should be used. This will reduce
the need for folding claims, reducing the amount of claims damaged during the opening process.
Claims should not be rubber banded or stapled together. When folding claims, one of the “thirds” should
be larger than the other two. This will leave a small amount of space in the envelope that will allow our
envelope slicing and extracting equipment to open the envelope without damaging the claims. DO NOT
FOLD CLAIMS INTO EQUAL SECTIONS.

Envelopes should also contain similar contents. For example, one envelope should contain claims, another
should contain correspondence. The time it takes to process all items received will improve if different items
are mailed separately.

PO Box Usage Reminder

Providers are encouraged to use the appropriate PO Box designated for each state’s Medicare correspondence.

When mail is sent to our street address, the process to open, sort and distribute the envelope contents is
dramatically slowed.

When sending Medicare Part B correspondence, such as claims, written inquiries, written appeals, hearings
and checks to Noridian Administrative Services, please use the appropriate PO Box for timely processing.

Do not use the street address included in the return address portion of NAS Medicare Part B envelopes.
Address your envelope to:
Medicare Part B
PO Box XXXX
Fargo, ND 58108-XXXX
(Substitute XXXX with the applicable PO Box Number listed below)


For providers who practice in border cities and have offices in each state, i.e., Washington and Oregon or
Nevada and Arizona, these claims must be mailed in separate envelopes based on where the services were
rendered. This information should also be included in Item 32 of the CMS–1500 claim form if it is different
from the information entered in Item 33.

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