How do you complete the Medicare CMS-1450 institutional claim form?

The rule, word for word

“This section contains Medicare requirements for use of codes maintained by the NUBC that are needed in completion of the Form CMS-1450 and compliant Accredited Standards Committee (ASC) X12 837 institutional claims. Note that the internal claim record used for processing is not being expanded. Instructions for completion are the same for inpatient and outpatient claims unless otherwise noted. The A/B MAC (A) or (HHH) does not need to search paper files to annotate missing data unless it does not have an electronic history record. It does not need to obtain data that is not needed to process the claim. Effective June 5, 2000, CMS extended the claim size to 450 lines. For the Form CMS- 1450, this simply means that the A/B MAC (A) or (HHH) accepts claims of up to 9 pages. The following layout describes the data specifications Form CMS-1450. FORM CMS-1450 LAYOUT SUMMARY FL Description Line Type Size Buffer Space FL01 [Billing Provider Name] 1 AN 25 FL01 [Billing Provider Street Address] 2 AN 25 FL01 [Billing Provider City, State, Zip] 3 AN 25 FL01 [Billing Provider Telephone, Fax, Country Code] 4 AN 25 FL02 [Billing Provider’s Designated Pay-to Name] 1 AN 25 FL02 [Billing Provider’s Designated Pay-to Address] 2 AN 25 FL02 [Billing Provider’s Designated Pay-to City, State] 3 AN 25 FL02 [Billing Provider’s Designated Pay-to ID] 4 AN 25 FL03a Patient Control Number AN 24 FL03b [...]”

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