Get the free The Revised CMS-1500 Form at a Glance - Medical Arts Press

The Revised CMS-1500 Form at a Glance The Office of Management and Budgets (OMB) has approved a revised CMS-1500 health insurance claim form (version 02/12) to replace the current form (version 08/05).

How to fill out the revised cms-1500 form

How to fill out the revised CMS-1500 form:

1. Begin by entering your personal information in the designated fields. This includes your name, address, and contact information.
2. Next, provide the information of the insured individual for whom the healthcare services are being claimed. This includes their name, date of birth, and insurance policy number.
3. Proceed by providing the information of the referring or ordering physician, if applicable. This includes their name, address, and National Provider Identifier (NPI) number.
4. In the following sections, you will need to enter the details of the patient's medical condition and the services provided. Provide specific information, such as diagnosis codes, procedure codes, and dates of service.
5. When filling out the form, always ensure accuracy and detail. Double-check all the provided information to avoid any errors or omissions that could lead to claim denials or delays.
6. Finally, sign and date the form to authenticate the information you have provided.

Who needs the revised CMS-1500 form:

1. Healthcare providers: Physicians, therapists, nurses, and other healthcare professionals who offer services to patients and seek reimbursement from insurance companies or government programs.
2. Medical billing and coding professionals: Individuals responsible for accurately documenting and submitting insurance claims on behalf of healthcare providers.
3. Insurance companies: The revised CMS-1500 form is used by insurance companies to process and evaluate claims submitted by healthcare providers.

For pdfFiller’s FAQs

What is the revised cms-1500 form?

The revised CMS-1500 form is the standard claim form used by healthcare professionals to bill insurance carriers for medical services.

Who is required to file the revised cms-1500 form?

Healthcare professionals and providers who render medical services to patients and want to seek reimbursement from insurance carriers are required to file the revised CMS-1500 form.

How to fill out the revised cms-1500 form?

The revised CMS-1500 form should be filled out with accurate and detailed information about the medical services provided, the patient's personal and insurance information, and the healthcare provider's information.

What is the purpose of the revised cms-1500 form?

The purpose of the revised CMS-1500 form is to facilitate the billing process for medical services by providing a standardized format for healthcare professionals to submit claims to insurance carriers.

What information must be reported on the revised cms-1500 form?

The revised CMS-1500 form must include the patient's personal information, insurance information, the provider's information, the date and description of services provided, and the charges for those services.

How can I send the revised cms-1500 form for eSignature?

When your the revised cms-1500 form is finished, send it to recipients securely and gather eSignatures with pdfFiller. You may email, text, fax, mail, or notarize a PDF straight from your account. Create an account today to test it.

Can I create an electronic signature for the the revised cms-1500 form in Chrome?

You can. With pdfFiller, you get a strong e-signature solution built right into your Chrome browser. Using our addon, you may produce a legally enforceable eSignature by typing, sketching, or photographing it. Choose your preferred method and eSign in minutes.

How do I fill out the the revised cms-1500 form form on my smartphone?

You can quickly make and fill out legal forms with the help of the pdfFiller app on your phone. Complete and sign the revised cms-1500 form and other documents on your mobile device using the application. If you want to learn more about how the PDF editor works, go to pdfFiller.com.