Corporate

Claim Page 04 – Entering a Hospice Claim

Claim Page 04 (Map 1714) provides space for you to key remarks that include pertinent information to assist the processing of the claim.


Key:

  • RED = Required field
  • BLUE = Optional field
  • GREEN = Conditional field, dependent on the type of claim
  • PURPLE = System generated field
  • BLACK = Not required field

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Field Descriptions for Claim Page 04 – Map 1714

The MID, TOB, S/Loc and PROVIDER fields are system generated from information on Claim Page 01.

Field Name/Requirement Description
REMARKS Optional

Enter any additional pertinent information to assist the processing of the claim.

  • Transfer claims: hospices are required to include the name and address of the hospice the patient is transferring to/from. Include the date of the remark and your initials.
  • Exception Requests: when submitting an exception request due to a late submission of an NOE, clearly indicate the circumstances and time frames to allow CGS to research the case. If possible, CGS will make a determination without requesting additional documentation. Refer to SE1633External PDF for additional information.

Three pages are available to make remarks. Each page holds 10 lines of remarks. Press F6 to scroll forward to the next remark page. CGS may also use this field to relay information back to the provider when the claim is in process or processed.

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Additional FISS Claim Pages

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Updated: 10.05.18

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