All paper claims must be submitted on the current HCFA CMS-1500 (02/12) or current UB-04 CMS-1450 claim form. The official current forms are the only versions accepted by South Dakota Medicaid for each claim type.
Responsibility for Accurate Claims
The provider is ultimately responsible for the accuracy of claims filed for services. We recommend that providers set a policy to ensure all necessary information is included on the initial claim submission and the information is correct. Providers should refer to our billing manuals for guidance in filling out claims.
Guidelines for Submitting Clean Paper Claims
South Dakota Medicaid uses optical character recognition (OCR) to process paper claim forms. OCR is a means of inputting text into a computer. It involves scanning a paper document to create a digital image of the text and then using software to store knowledge about that digital image. With OCR, it is very important providers follow proper paper claim submission guidelines.
Failure to follow these guidelines could cause a denial, delay in processing, return of the claim, or affect payment accuracy. There may be some exceptions made for small providers that submit less than 200 claims per year.
Font and Printing
The OCR equipment is sensitive to ink color. Follow these guidelines on ink color:
Avoid using old or worn ink cartridges, toner cartridges, or printer ribbons.
To process a claim correctly, proper alignment of the claim form information is necessary. The OCR equipment may not read information that is not aligned properly, resulting in unnecessary denials or incorrect payment. To properly align data on the claim form, do the following:
Handwritten claims are difficult to read; therefore, they take longer to process. The OCR equipment may misread the information, resulting in the entry of invalid information for the claim. To ensure timely and accurate processing of claims, South Dakota Medicaid requires claims to be typed, not handwritten.
Additional Guidelines and Tips
Preprogrammed, Preprinted Information
Do not use preprinted or preprogrammed information on the CMS-1500 claim form. An example of preprinted or preprogrammed information is a qualifier of "ZZ in Locator 24I on all six detail lines but only submitting one claim detail line.
The area of most concern for preprinted or preprogrammed information is Locator 24 and the bottom of the claim form. Preprinted information in these areas cause the OCR equipment to read information not intended for the specific field.
Ordering Claim Forms
In order to purchase claim forms, contact the U.S. Government Printing Office at 1.866.512.1800, local printing companies, and/or office supply stores. There may be cheaper options available for purchase online, but we cannot guarantee their quality. You can also purchase claim forms online from: https://bookstore.gpo.gov/