Get the free Revised CMS-1500 Paper Claim Form

December 2013 Coming Soon! Revised CMS-1500 Paper Claim Form (Version 02/12) Effective Jan. 6, 2014, the National Uniform Claim Committee (NCC) will release a revised version of the CMS-1500 paper

How to fill out revised cms-1500 paper claim

How to fill out revised CMS-1500 paper claim:

1. Start by obtaining the revised CMS-1500 paper claim form. It is essential to use the updated version to ensure accuracy and compliance with current billing requirements.
2. Fill in the provider information section at the top of the form. Include the name, address, and contact details of the healthcare provider or organization submitting the claim.
3. Identify the patient by providing their name, date of birth, gender, and address in the patient information section.
4. Indicate the patient's insurance information accurately, including the primary and secondary insurance if applicable. Include the insurance company's name, address, and policy number.
5. Document the service or procedure provided by entering the appropriate healthcare procedure codes in the designated fields. Ensure that the codes accurately reflect the services rendered and are supported by appropriate documentation.
6. Specify the diagnosis codes related to the services provided. Use the appropriate International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes to accurately represent the patient's condition.
7. Include the date of service for each procedure or service performed. Ensure that the dates align with the order of the services listed on the claim form.
8. Calculate and enter the charges for each service provided. This should include the individual fees for each procedure, any applicable modifiers, and the total amount due.
9. If applicable, indicate any previous payments received from the patient or insurance company by entering the payment amounts in the designated fields.
10. Review the completed claim form for accuracy and completeness. Ensure that all required fields are filled out, and the information provided is legible.
11. Keep a copy of the completed CMS-1500 paper claim for your records before submitting it to the appropriate payer.

Who needs the revised CMS-1500 paper claim:

1. Healthcare providers: Physicians, hospitals, clinics, and other healthcare professionals who bill for services provided to patients.
2. Medical billing and coding professionals: Individuals responsible for accurately completing and submitting insurance claims on behalf of healthcare providers.
3. Insurance companies: Payers who review and process the claims submitted by healthcare providers to determine coverage and reimbursements.

For pdfFiller’s FAQs

What is revised cms-1500 paper claim?

Revised CMS-1500 paper claim is a form used by healthcare providers to submit claims for reimbursement from insurance companies or government programs.

Who is required to file revised cms-1500 paper claim?

Healthcare providers such as physicians, clinics, and hospitals are required to file revised CMS-1500 paper claims.

How to fill out revised cms-1500 paper claim?

Revised CMS-1500 paper claims can be filled out manually or electronically with the required patient information, provider details, and service codes.

What is the purpose of revised cms-1500 paper claim?

The purpose of revised CMS-1500 paper claim is to request reimbursement for healthcare services provided to patients.

What information must be reported on revised cms-1500 paper claim?

Revised CMS-1500 paper claims must include patient demographics, provider information, diagnosis codes, procedure codes, and charges for services.

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