Knowledge Center

Claim Form 1500

 Medical insurance claim re-imbursement is a complex process involving a number of steps including filling up of CMS 1500 claim form. There are a number of claim forms, however, this claim form is one of the basic forms required to be filled up by medical providers for reimbursement. These are pre-printed red and white forms designed by the Centers for Medicare and Medicaid Services. They were formally known as HCFA 1500 forms but they were redesigned to allow for the reporting of the National Provider Identifier (NPI).

CMS 1500 claim form is used by the individual providers who qualify for waiver from the government as a result of meeting all the requirements for electronic claim submission. Paper claim forms have become a rare commodity today and are made available by the United States government to those who would like to bill regional suppliers of durable medical equipment. The design and the maintenance of this CMS 1500 form is the very responsibility of the national uniform claim committee.

The information required in the CMS 1500 claim form may differ from one insurance carrier to another. For example, if you are billing an insurance carrier that requires authorization for the services being billed and they assign an authorization number, they may require that the authorization number be in box 23. Other carriers do not require that anything be in box 23. It is important to know the different requirements for each of the insurance carriers that you bill to.

The information entered in the CMS 1500 claim forms should be error free to ensure that correct payment is made. If the form is not completed properly, the claim may be denied by the insurance carrier. Many providers have practice management software that completes the forms for them, but the information must still be loaded into the practice management software program properly in order for it to be printed out in the right format.

In normal practice CMS 1500 claim forms are scanned by the insurance carriers and if all the required fields are not completed the claim is automatically denied without a human even touching it. Another thing that could cause an immediate denial is if the date of birth on the claim doesn't match what's on file with the insurance carrier. When the claim is scanned, it will deny out stating they can't identify the patient.

The reimbursement process by and large depends on medical billing coding (service line, diagnostic code) and correct filling up of the form. Many claims do not get paid on the first submission and in many cases it is due to the CMS 1500 claim form not being completed properly. In order to cut down on denials, make sure you are completing the forms completely and correctly.

ClaimatTM: Claimat is an integrated healthcare connectivity application providing cost effective, self-sufficient and direct connectivity products and services for the healthcare industry. Claimat is an easy to use claims submission and management system.