1500 Paper Claim Submission

Policy Number: GP-P-011

Last Updated: May 24, 2022 

Paper claims are entered into our claim processing system by transforming information on paper claims to an electronic format. If the claim cannot be entered electronically, it is delayed for research and entered manually by an auditor. When submitting paper claims with multiple pages, please label pages as “1 of 2,” “2 of 2,” and total the final page as the total billed charge to ensure the claim is loaded as one claim and not split into multiple claims per page.  

A Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandate limits the number of lines that can be submitted on one paper claim. 

Claim Type Line limit maximum
Institutional 999 lines
Professional 50 lines

Claims can be mailed to:  
Blue Cross and Blue Shield of Nebraska  
P.O. Box 3248  
Omaha, NE 68180-0001  
To expedite paper claim processing:  

  • Text must be printed clearly  
  • Keep all text inside the lines  
  • Text must be dark  
  • Dates must be numeric and six positions (mmddyy)  
  • Don’t use nicknames or “Baby Girl,” “Baby Boy” as the patient’s name  
  • Print - do not write in script  
  • Print the entire ID number in Box 1a - including the prefix  
  • Current CPT codes (Box 24D) and current diagnosis (Box 21) codes are needed, but nomenclature is not needed unless you are billing an unlisted or miscellaneous CPT code

Provider name and identification numbers on CMS 1500 forms must correspond with information we have on our provider data file.