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Claim Page 06 – Entering a Hospice Claim

Claim Page 06 (Map 1716) contains additional insurer information when Medicare is the secondary payer.  No information should be entered on FISS Claim Page 06.  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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