Insurance claim that has been canceled, deleted, or voided by a Medicare fiscal intermediary for the following reasons: CMS-1500 (08-05) or current CMS-1450 is not used, itemized charges are not provided, more than six line items are submitted on the CMS-1500 (08-05) claim form, patient’s address is missing, internal clerical error was made, Certificate of Medical Necessity (CMN) was not with the Part B claim or was incomplete or invalid, and name of the store is not on the receipt that includes the price of the item.