Get the free CMS-1500 (02/12) Paper Claim Definitions Revised: 1

CompuGroup Medical US CMS1500 (02/12) Paper Claim Definitions Revised: 1.13.20171CMS1500 (02/12) PAPER CLAIM DEFINITIONS The following information has been compiled to assist while troubleshooting

How to fill out cms-1500 0212 paper claim

How to fill out cms-1500 0212 paper claim

1. To fill out the CMS-1500 0212 paper claim form, follow these steps:
2. Begin by entering the patient's personal information in Box 1 to 9, including their name, address, and phone number.
3. In Box 10, enter the patient's birth date, gender, and marital status.
4. In Box 11, provide the patient's insurance information, such as the policy number and group number.
5. Indicate the patient's relationship to the insured in Box 12.
6. Boxes 13 to 16 are used for referring physician or other source information.
7. In Box 17, enter the referring or ordering provider's information.
8. Use Boxes 18 to 28 to list the diagnosis codes and corresponding dates of service.
9. Box 29 should be used for indicating the total charges for the service.
10. In Box 30, provide information related to the referring or ordering provider.
11. Boxes 31 to 33 are for additional billing information, including signature and date.
12. If there are any additional documentation or attachments, indicate them in Boxes 34 to 36.
13. Lastly, make sure to review the completed form for accuracy and completeness before submission.

Who needs cms-1500 0212 paper claim?

1. The CMS-1500 0212 paper claim form is needed by healthcare providers, such as physicians, hospitals, and clinics, who wish to bill insurance providers for the services they have rendered to patients.
2. It is also required for Medicare Part B claims and some private insurance payers.

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What is cms-1500 0212 paper claim?

CMS-1500 0212 paper claim is a standard claim form used by healthcare providers to bill insurance companies for services rendered to patients.

Who is required to file cms-1500 0212 paper claim?

Healthcare providers, such as doctors, hospitals, and clinics, are required to file CMS-1500 0212 paper claims for reimbursement of services provided to patients.

How to fill out cms-1500 0212 paper claim?

CMS-1500 0212 paper claim can be filled out manually or electronically using the required information such as patient demographics, insurance information, diagnosis codes, and procedure codes.

What is the purpose of cms-1500 0212 paper claim?

The purpose of CMS-1500 0212 paper claim is to request reimbursement from insurance companies for healthcare services provided to patients.

What information must be reported on cms-1500 0212 paper claim?

Information such as patient demographics, insurance information, diagnosis codes, procedure codes, and service dates must be reported on CMS-1500 0212 paper claim.