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Template for Electronic Filing of Bad Debt Listings

The following Excel template will help ensure consistency in filing, and will assist the fiscal intermediary (FI) in auditing the information submitted. Providers are encouraged to begin using this template.

To download the Excel template click here:  BadDebtTemplate.xls Excel file

We welcome any feedback and suggestions for improvements. Please send your feedback to steven.hartmann@empireblue.com.

 

Note External Link: Links with this graphic go to an external site outside of Empire Medicare Services and will open in a new window.

Note PDF File: You must have the Adobe Acrobat Reader (version 4.0 or higher) to view the PDF files. If you do not already have this software,  you can Download it here (This software is free!).

Note Excel Spreadsheet File: Some of the files on this page are available only in Microsoft Excel format. If you cannot view Excel spreadsheets, download the Excel Viewer.

 

   
 
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