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Insured's Name: If there is insurance primary to Medicare, either through the patient or spouse's employment or any other source, list the name of the insured here.

It fills in some of the 'gaps' in Medicare coverage by providing payment for some of the charges for which Medicare does not have responsibility due to the applicability of deductibles, coinsurance amounts or other limitations imposed by Medicare.

It does not include limited benefit coverage available to Medicare beneficiaries such as 'specified disease' or 'hospital indemnity' coverage.

Reminder: The Administrative Simplification and Compliance Act (ASCA) prohibits Medicare from making payments on claims not submitted electronically on or after October 16, 2003, unless a provider is small (fewer than 10 full-time equivalent employees for providers required to bill Medicare carriers) or meets one of the very few limited exceptions to this requirement.

Preparing the CMS-1500 Claim Form Palmetto GBA scans claim information from the CMS-1500 claim form into the processing system.

Claims that are not legible or properly coded will be returned or rejected.

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