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The HCFA 1500 claim form, also known as CMS-1500, enables medical facilities to submit health insurance claims to insurance carriers such as Medicare and Medicaid; this form can be sent electronically.


Instructions for Completing the CMS 1500 Claim Form The Center of Medicaid and Medicare Services (CMS) form 1500 must be used to bill SFHP for medical services. The form is used by Physicians and Allied Health Professionals to submit claims for medical services. All items must be completed unless otherwise noted in these instructions.


Form # CMS 1500 Form Title Health Insurance Claim Form Revision Date 2012-02-01 O.M.B. # 0938-1197 O.M.B. Expiration Date 2020-03-31 CMS Manual N/A Special Instructions Starting April 1, 2014 only the revised, 02-12 version will be accepted.


Otherwise, here is an abridged version of instructions to fill out the HCFA 1500 Claim Form: Required fields on the form are marked " REQUIRED ". Patient Information (blocks 2-8).


The CMS-1500 is a standard claim form used by all non-institutional medical providers or suppliers to bill Medicare carriers and durable medical equipment carriers when a provider qualifies for a waiver of electronic submission of claims. This paper claim form is also used for billing certain Medicaid state agencies.


Making sense of Medicare paperwork, including the HCFA 1500 claim form, can be difficult. For that reason, here are some tips and a sample form to assist you. Please note that the lettered items on this page refer to letters printed on the sample form. A. Printed in the upper left-hand corner of your HCFA 1500 claim form are the name and


HCFA 1500: Managed care The official standard form used by physicians and other providers when submitting bills/claims for reimbursement to Medicare or Medicaid for health services; it is also used by private insurers and managed care plans; HCFA 1500 contains Pt demographics, diagnostic codes, CPT/HCPCS codes, diagnosis codes, units. See ...


Professional Paper Claim Form Skip to Main Content. Home - Opens ... Professional Paper Claim Form (CMS-1500) How to Submit Claims: Claims may be electronically submitted to a Medicare carrier, Durable Medical Equipment Medicare Administrative Contractor (DMEMAC), or A/B MAC from a provider's office using a computer with software that meets ...


CMS-1500 FORM FIELDS & DESCRIPTION FIELD NUMBER & DESCRIPTION 1. PAYER TYPE of the destination payer. 1.a. Patient INSURED # of the destination payer in the Insurance Information screen under Patient Master. 2. PATIENT NAME from Patient Master. 3. Patient DOB and SEX from Patient Master. 4.


CMS-1500 Claim Form Crosswalk to EMC Loops and Segments This crosswalk is not intended to be an all inclusive list of every possible electronic media claim (EMC) loop and segment for a particular item on the paper claim form.