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National Uniform Claim Committee02/12 1500 Claim Form Map
to the
X12 Health Care Claim:
Professional (837)August 2018
Version 3.3 8/18The 1500 Claim Form Map to the X12 Health Care Claim: Professional
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How to fill out 1500 form mapping to
How to fill out 1500 form mapping to
01
Step 1: Start by entering the patient's personal information, including their name, address, and contact details.
02
Step 2: Provide the patient's insurance information, such as the policy number, group number, and the name of the insurance company.
03
Step 3: Fill out the information related to the healthcare provider or facility, including their name, address, and contact details.
04
Step 4: Specify the services provided to the patient, including the date of service, the procedure codes, and the diagnosis codes.
05
Step 5: Include any additional documentation required, such as medical reports or referral letters.
06
Step 6: Calculate the total charges for the services rendered and indicate any payments or adjustments.
07
Step 7: Review the completed form to ensure accuracy and completeness.
08
Step 8: Submit the filled-out 1500 form to the appropriate party, such as the insurance company or billing department.
Who needs 1500 form mapping to?
01
Medical professionals and healthcare facilities, such as doctors, hospitals, clinics, and laboratories, need the 1500 form mapping to. It is used for billing purposes to claim reimbursement from insurance companies for the medical services provided to patients.
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