Health care and medical services providers use the CMS-1500 health insurance claim form in either its paper or electronic form to submit bills to Medicare, Medicaid and the majority of private insurance companies, according to EMR Consultant, Providers fill in the required data elements using standardized codes and formats.
Whether completed on paper or electronically, the CMS-1500 must include certain information entered into the appropriate boxes and fields, following specified formats, for the claim to be accepted by Medicare or other payers, explains Noridian Healthcare Solutions. Health care providers or medical billing clearinghouses use the CMS-1500 to provide information about services performed on or behalf of a patient and to request payment for those services. Required information includes the date of service, health care provider National Provider Identifier number, patient demographics, medical diagnoses and procedural codes that identify the specific services provided.
In 2001, the Health Care Financing Administration, which was the federal agency responsible for the administration and oversight of the Medicare and Medicaid programs as well as related quality assurance activities, changed its name to the Centers for Medicare and Medicaid Services, according to the Federal Register. The CMS-1500 Claim Form replaced the HCFA-1500 form, according to EMR Consultant.