CMS 1500 forms are the universal claim forms used by medical providers to submit claims for their services to the insurance carriers. They 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 NPI, or National Provider Identifier.

It is very important that the CMS 1500 forms are completed properly 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.

Many of the insurance carriers have different requirements for what information goes in each box on the CMS 1500 form. 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.

If you do not have all of the necessary boxes completed, or if they are not completed properly, the claim may be denied. For example, if you do not put the patient’s date of birth on the CMS 1500 form, then the claim will most likely be denied out. Most insurance carriers scan the CMS forms 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.

Many claims do not get paid on the first submission and in many cases it is due to the CMS form not being completed properly. In order to cut down on denials, make sure you are completing the forms completely and correctly. This will make a big difference in your bottom line.

Copyright 2008 – Michele Redmond



Source by Michele Redmond