Paper Claims with Attachments

Paper Claims with Attachments

 When submitting attachments with the CMS-1500 claim form, please follow these guidelines:

Any attachment should be marked with the beneficiary’s name and Medicaid ID number.
For different claims that refer to the same attachment, a copy of the attachment must accompany each claim.
For claims with more than one third- party payor source, include all EOBs that relate to the claim.
For third party payments less than 20% of charges, indicate on the face of the claim, LESS THAN 20%, PROOF ATTACHED.
For Medicare denials, indicate on the claim, MEDICARE DENIAL, SEE ATTACHED.
For other insurance denials, indicate on the claim, TPL DENIAL, SEE ATTACHED

 When submitting attachments with the CMS-1500 claim form, please follow these guidelines:

Any attachment should be marked with the beneficiary’s name and Medicaid ID number.
For different claims that refer to the same attachment, a copy of the attachment must accompany each claim.
For claims with more than one third- party payor source, include all EOBs that relate to the claim.
For third party payments less than 20% of charges, indicate on the face of the claim, LESS THAN 20%, PROOF ATTACHED.
For Medicare denials, indicate on the claim, MEDICARE DENIAL, SEE ATTACHED.
For other insurance denials, indicate on the claim, TPL DENIAL, SEE ATTACHED

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