What Information Needs to Be Included in a CMS 1500 Form?


Quick Answer

A CMS 1500 form must include a patient's type of injury or illness, date of hospitalization or medical treatment, and the associated fees charged by the doctor submitting the claim. The patient's basic identifying information and insurance policy details must also be included.

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Full Answer

Medical service providers use the CMS 1500 form to submit health insurance claims for patients covered by Medicare, Medicaid and other government insurance programs, including Tricare. While these claims can be submitted electronically, many doctors' offices still use the paper version of the form.

The CMS 1500 is easily identified by its signature red ink on white paper. Medical billers must fill out the CMS 1500 completely and without errors so the provider can promptly receive insurance payments. In addition, medical billers must be formally trained in how to fill out this form. There are various requirements for insurance coding on the form, corresponding to the type of service and specific insurance policy.

The previous version of the CMS 1500 form was called the HCFA 1500. In 2007, changes were made to more easily keep track of medical providers via the National Provider Identifier. The NPI is a unique number assigned to a provider which makes insurance records more streamlined and electronically accessible.

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