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What is the history of the CMS 1500 claim form?

The CMS 1500 is the red ink on white paper standard claim form used by physicians and suppliers for claim billing. Although it was developed by The Centers for Medicare and Medicaid (CMS), it has become the standard form used by all insurance carriers. CMS designates the 1500 Health Insurance Claim Form as the CMS-1500 (08/05). Although a copy of the CMS-1500 form can be downloaded, copies of the form cannot be used for submission of claims, since your copy may not accurately replicate the scale and OCR color of the form. The CMS-1500 Claim Form has been recently revised with changes including those to more adequately support the use of the ICD-10 diagnosis code set. The revised CMS-1500 form (version 02/12) will replace version 08/05. It provides information about the client, their corresponding insurance policy, and their diagnosis and treatment. Additionally, most insurance firms allow you to send an electronic version, called an 837 file

Who can bill claims using the CMS 1500?

The CMS-1500 form is the health insurance claim form used for submitting physician and professional claims for providers. When a physician has a private practice but performs services at an institutional facility such as a hospital or outpatient facility, the CMS-1500 form would be used to bill for their services. The CMS 1500 claim form is currently the only accepted form for submitting paper claims to both government and commercial health insurance carriers.

How many sections are there in the CMS 1500?

There are two sections to the CMS-1500; the top portion is for the patient/insured information (Blocks 1-13); the bottom portion is for the physician/supplier information (Blocks 14-33). In the later section entitled “Completing the CMS-1500,”

How many diagnoses can be reported on the CMS 1500?

if your claim contains more than one charge, then more than four diagnosis codes may be reported. but only four diagnosis codes will be reported for each charge. you can see an example when you print a cms1500 paper for. Click on the link below for a free health insurance claim form 1500 download


Download health insurance claim form 1500

Document Credit: Centre for Disease Control (CDC) 


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