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Last Modified: 11/2/2018 Location: FL, PR, USVI Business: Part B

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

Tired of paper?

First Coast Service Options (First Coast) has noticed a reoccurring issue for several claims when they go through the optical character recognition (OCR) process. To avoid these issues, we wanted to reiterate some important instructions for 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.
When completing the claim form, ensure to use all capital typeface. This is especially important when indicating letter "I" and "L" in Item 24E.
Claims submitted with a national provider identifier (NPI) and without one of the Item 17 qualifiers or an invalid qualifier will be 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.