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Last Modified: 2/11/2021 Location: FL, PR, USVI Business: Part B

Important instructions for paper claim form CMS-1500 (version 02/12)

Tired of paper?

First Coast has noticed an increase in errors for claims submitted on the CMS-1500 (02/12) claim form when going through the optical character recognition (OCR) scanning process. To avoid these issues, we wanted to reiterate some important instructions to our paper claim submitters:
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. Handwritten forms can cause delays and errors in processing and slow down time for reimbursement.
Ensure to use all capital typeface with Courier New or Tines New Roman font style and size 10. This is especially important when indicating letter "I" and "L" in Item 24E.
Maintain the same font type and size on the entire form.
Use black ink only. Do not use red or blue ink as the scanner is unable to “read” the data and can cause your claims to be returned as unprocessable.
Do not use a rubber stamp for any fields on the CMS-1500 (02/12) claim form.
Do not use correction fluid or correction tape.
Avoid the use of special characters.
Do not highlight the claim form or attachments.
Periodically review the fields spacing and placement of information contained within Items 1-33 when using computer printed or typed CMS 1500 (02/12) claim forms. Information should only be located within the specified block placement on the form.
Claims submitted with a national provider identifier (NPI) and without one of the Item 17 qualifiers or an invalid qualifier will returned as an unprocessable claim (RUC).

ASCA reminder

Only providers that meet the Administrative Simplification Compliance Act (ASCA) exception requirements are permitted to submit their claims to Medicare on paper, which must be submitted on a valid CMS-1500 claim form. Providers meeting these exceptions are permitted to submit their claims to Medicare on paper.
More information about ASCA exceptions can be found in Chapter 24 of the Medicare Claims Processing Manual.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.