A CMS 1500 form is a unique form used by doctors and healthcare providers to submit medical claims to insurance companies. These claim forms are only used by non-institutional providers. Hospital facilities use a different type of claim form to submit their claims.
The CMS 1500 form consists of a grid-like format that contains many different boxes that give the insurance companies several pieces of information needed to process a claim. Below are examples of some of the labels on the individual boxes.
Patient Demographic Information
Patient’s DOB (date of birth)
Patient’s Insurance ID Number
Patient’s Visit Information
CPT Code – Specialized coding system used by doctors to describe a procedure
Modifier – Specialized coding system that further describes the procedure
Charge Amount – Amount that the provider charges for the service
Rendering Provider Information – Name of the doctor that performed the service
Billing Provider Information – Billing information regarding where the claim should be paid
Service Center Information – Location where the patient had their services rendered
There is also a large box in the middle of the form that asks the provider to specify if the procedure codes (CPT codes) result from a work or automobile injury. This box is widely used for workers’ compensation claims as well as motor vehicle accidents.
CMS 1500 and Insurance
Each individual box on the form contains vital information that insurance companies need to process the claims for their members. This document was created to simplify this process and to assist the insurance providers. The forms can be printed and mailed to an insurance company, or they can be sent electronically. Many large insurance corporations request electronic claim forms because it ensures a quicker processing time and saves paper.
This form is the only approved claim form that can be used by non-institutional providers to submit medical claims. Using an old or outdated version of this form would be rejected by insurance carriers.
Learn to Use CMS 1500
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