1500 Health Insurance Claim Form

One of the most important forms in Medical Billing and Coding Jobs

1500 Health Insurance Claim Form – What is it and Important Tips for completing. This is probably the most important form in medical billing and coding careers. Below is a great resource for learning how to correctly complete the form.

If you’ve had any medical billing coding training, you probably learned quickly the importance of and became very familiar with the CMS 1500 claim form.

The CMS 1500 claim form is currently the only accepted form for submitting paper claims to both government and commercial health insurance carriers. It is printed in red ink as shown on the right. The only forms accepted are the “official” forms printed in Flint OCR Red (J6983) ink.

There are lots of copies of the form available for download, but these cannot be used for submission because the red ink cannot be accurately reproduced. Most claims sent to insurance carriers are scanned using an optical character recognition scanner. This converts the information on the form into electronic format for processing by the carrier.

The CMS 1500 claim form (dated 08-05) replaced the outdated HCFA 1500 health insurance claim form (dated 12-90). One of the biggest changes for the CMS 1500 is the addition of the NPI field. There are several vendors who sell the CMS-1500 claim form in various configurations such as single sheet, continuous feed, laser, etc.

The NUCC (National Uniform Claim Committee) will be releasing the new CMS 1500 form soon – designated as the 02/12 form. The form is being updated to accommodate the changes in 5010, 837P and 5010A1 as well as prepare for the implementation of ICD-10.  The changes will make the paper CMS form agree with electronic claim forms.

June 1st of 2013 providers can begin using the 02/12 CMS 1500 health insurance claim form. By October of 2013 the 02/12 version will replace the 08/05 version. After October 1st of 2013 the 08/05 version will no longer be accepted by insurance carriers – even if billing for an old claim.

Important tips for completing the CMS 1500 form:

  • Make sure the fields are properly aligned. Some practice management software may not line up the boxes properly which can lead to rejected claims. Check with your software vendor to make sure you have the latest CMS 1500 form.
  • Use only black 10-point plain font without any effects such as italics, script, or stylized fonts.
  • Use only upper-case capital letters.
  • Do not use dollar signs, decimals, or punctuation.
  • Follow the correct Health Insurance Claim Number (HICN) format with no hyphens or dashes.. The alpha prefix or suffix is part of the HICN and should not be omitted.
  • Make sure data is in the appropriate field and does not overlap into other fields.
  • Use an individual’s name in the provider signature field – not a facility or practice name.
  • Include all applicable NPIs on the claim. This includes the referring provider NPI.
  • Include special certification numbers for services such as clinical laboratory (CLIA number) or mammography (FDA number).
  • Don’t staple, clip, or tape anything to the CMS 1500 form.
  • Is free from tears, crumples, or excessive creases. Recommend submitting claims in a full letter size envelope.
  • Clean and free from stains, handwritten notations, circles or scribbles, strike-overs, crossed-out information or white out.

If you need help filling out the CMS 1500 form, “How To Complete A CMS 1500 Form” on our Medical Billing Books page is a helpful and comprehensive Line by Line “how-to” guide to filling out the CMS 1500 form. Includes Easy to understand Line by line and box by box instructions.

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