Get the free 837 Professional/CMS-1500 Claim Form - PA Department of ...

Pennsylvania Department Of Human Services Emperor Status CODE Descriptions201BILLING PROVIDER IDENTIFICATION NUMBER IS MISSING FROM CLAIM202BILLING PROVIDER IDENTIFICATION NUMBER IS IN INVALID FORMAT203DATE

How to fill out 837 professionalcms-1500 claim form

How to fill out 837 professionalcms-1500 claim form

1. To fill out the 837 professional/CMS-1500 claim form, follow these steps:
2. Start by entering the patient's information at the top of the form. This includes their name, address, and insurance policy number.
3. In the next section, provide the payer information. This includes the name and address of the insurance company or payer.
4. Fill in the patient's identification number, as assigned by the payer, in the appropriate field.
5. Indicate the patient's date of birth and gender in the designated spaces.
6. Moving on to the next section, enter the date of current illness, injury, or pregnancy for which the claim is being filed.
7. Provide the service facility location information, including the name, address, and ZIP code.
8. Indicate whether the claim is for a new or established patient by checking the appropriate box.
9. Enter the appropriate diagnosis code(s) in the designated fields. These codes should accurately represent the patient's condition.
10. Provide the procedure code(s) and date(s) of service for each service rendered to the patient.
11. If applicable, indicate the referring provider's name, address, and NPI number in the designated fields.
12. Fill in the appropriate charges for each procedure/service provided.
13. Calculate the total charges for services rendered and enter the amount in the designated space.
14. If there are any additional notes or comments regarding the claim, include them in the designated section.
15. Finally, sign and date the claim form to certify its accuracy and completeness.
16. Remember to review the completed form for any errors or omissions before submitting it to the insurance company or payer.

Who needs 837 professionalcms-1500 claim form?

1. The 837 professional/CMS-1500 claim form is needed by healthcare providers, such as physicians, dentists, chiropractors, and other medical professionals, who wish to file a claim for reimbursement of their services.
2. It is also required by medical billing companies and other entities involved in the healthcare billing process.

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What is 837 professionalcms-1500 claim form?

837 professionalcms-1500 claim form is the standard form used by healthcare professionals to submit claims for reimbursement for healthcare services provided to patients.

Who is required to file 837 professionalcms-1500 claim form?

Healthcare professionals such as doctors, nurses, and therapists are required to file 837 professionalcms-1500 claim form when seeking reimbursement for services provided to patients.

How to fill out 837 professionalcms-1500 claim form?

To fill out 837 professionalcms-1500 claim form, healthcare professionals must provide patient information, healthcare service details, and insurance billing information in the designated fields on the form.

What is the purpose of 837 professionalcms-1500 claim form?

The purpose of 837 professionalcms-1500 claim form is to request reimbursement from insurance companies for healthcare services provided to patients.

What information must be reported on 837 professionalcms-1500 claim form?

Information such as patient demographics, dates of service, diagnosis codes, procedure codes, and insurance billing details must be reported on 837 professionalcms-1500 claim form.