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1500 Claim Submission Guide1500 Claim Submission Guide April 2018Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East, and
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How to fill out independence blue cross cms-1500
How to fill out independence blue cross cms-1500
01
Start by obtaining the CMS-1500 form. This form can be downloaded from the Independence Blue Cross website or obtained through other means.
02
Fill in the patient's information on the top section of the form. This includes the patient's name, address, date of birth, and insurance information.
03
Enter the healthcare provider's information in the designated section. This includes the provider's name, address, and National Provider Identifier (NPI) number.
04
Provide the insurance information in the applicable fields. This includes the policy number, group number, and any other relevant details.
05
Describe the services rendered in the designated area. Include the diagnosis codes, the CPT or HCPCS codes, and any modifiers if applicable.
06
Indicate the charges for each service and any adjustments or discounts in the respective columns.
07
Complete the provider's certification statement, ensuring all required fields are filled in correctly.
08
Sign and date the CMS-1500 form to validate the information provided.
09
Make copies of the completed form for your records.
10
Submit the completed CMS-1500 form to Independence Blue Cross using the designated method specified by the insurer.
Who needs independence blue cross cms-1500?
01
Independence Blue Cross CMS-1500 form is primarily needed by healthcare providers who render services to patients covered by Independence Blue Cross insurance.
02
Patients who receive healthcare services from providers affiliated with Independence Blue Cross may also encounter the CMS-1500 form, either for their personal records or to submit claims for reimbursement.
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What is independence blue cross cms-1500?
The Independence Blue Cross CMS-1500 is a claim form used by healthcare providers to bill for services rendered to patients.
Who is required to file independence blue cross cms-1500?
Healthcare providers who have rendered services to patients and wish to receive payment from Independence Blue Cross are required to file the CMS-1500 form.
How to fill out independence blue cross cms-1500?
The Independence Blue Cross CMS-1500 form must be filled out with accurate information regarding the patient, services rendered, and provider details. It is important to follow the instructions provided on the form.
What is the purpose of independence blue cross cms-1500?
The purpose of the Independence Blue Cross CMS-1500 form is to allow healthcare providers to bill for services provided to patients and receive payment from Independence Blue Cross.
What information must be reported on independence blue cross cms-1500?
The Independence Blue Cross CMS-1500 form requires information such as patient's demographics, diagnosis codes, procedure codes, provider information, and service dates.
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