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Claim Page 05 – Entering a Hospice Claim

Claim Page 05 (Map 1715) will provide insured person(s) information once the claim is submitted. No information should be entered on FISS Claim Page 05. To submit Medicare Secondary Payer (MSP) claims and adjustments via the American National Standard Institute (ANSI) ASC X12N 837 5010 format or directly into the Fiscal Intermediary Standard System (FISS) via Direct Data Entry (DDE), refer to the "Medicare Secondary Payer (MSP) Billing and AdjustmentsPDF"quick resource tool or the Medicare Secondary Payer (MSP) Online Tool.

Additional FISS Claim Pages

Updated 01.23.17


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