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CMS 1500 forms are the universal claim forms used by medical providers to submit claims for their services to insurance carriers. They are pre-printed red and white forms designed by the Centers for Medicare and Medicaid Services. They were officially known as HCFA 1500 forms, but were redesigned to allow reporting of the NPI, or National Provider Identifier.
It is very important that the CMS 1500 forms are filled out properly to ensure payment is made correctly. Failure to complete the form properly may result in the insurance carrier denying the claim. Many providers have practice management software that fills out the forms for them, but the information still needs to be properly loaded into the practice management software so that it can be printed out in the correct format.
Many of the insurance carriers have different requirements for the information in each field of the CMS 1500 form. For example, if you bill an insurance carrier that requires authorization for the billed services and assigns them an authorization number, they may require the authorization number to be in field 23. Other carriers do not require anything to be in box 23. It is important to understand the different requirements for each insurance carrier you are billing with.
If you have not filled in all the required fields or if they are not filled out correctly, the claim may be rejected. For example, if you do not provide the patient’s date of birth on the CMS 1500 form, the claim will most likely be rejected. Most insurance carriers will scan the CMS forms and if all required fields are not filled out, the claim will be automatically denied without a human even touching it. Another thing that could result in an outright denial is if the date of birth on the claim doesn’t match what is on file with the insurance carrier. If the claim is scanned, they will deny it on the grounds that they cannot identify the patient.
Many claims are not paid on first submission and in many cases it is because the CMS form was not filled out correctly. To avoid rejections, make sure you fill out the forms completely and correctly. This will make a big difference in your bottom line.
Copyright 2008 – Michele Redmond
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