Get the free 837 ProfessionalCMS-1500 Claim Form

Pennsylvania Promise Provider Handbook 837 Professional/CMS1500 Claim Form October 2015, Version 2.24 837 professional main 101915.docx 1 October 19, 2015, This document contains confidential and

How to fill out 837 professionalcms-1500 claim form

How to fill out 837 professionalcms-1500 claim form:

1. Start by obtaining a copy of the 837 professionalcms-1500 claim form, which is typically available through healthcare providers, insurance companies, or from online sources.
2. Begin by entering your personal information in the top section of the form, including your name, address, and contact details. Make sure to provide accurate information for effective communication purposes.
3. Next, identify the patient for whom the claim is being filed. Enter their full name, date of birth, and insurance information, including policy number and group number if applicable.
4. In the "Provider Information" section, specify the details of the healthcare provider or facility where the services were rendered. Include their name, address, and National Provider Identifier (NPI) number.
5. Moving on to the "Patient Information" section, describe the patient's condition, including any diagnoses or symptoms, as well as the reason for the medical visit or procedure. Providing clear and concise information here is crucial for accurate processing of the claim.
6. Fill out the "Insurance Information" section by indicating the patient's primary insurance company, policy number, group number, and any other pertinent details. If there is secondary insurance coverage, you may also include that information in the corresponding fields.
7. Proceed to list the services provided to the patient in the "Procedure Information" section. Each service should be described individually, including the date of service, the CPT (Current Procedural Terminology) code, and the charge for each service. Ensure that the codes and charges align with the relevant medical documentation.
8. Attach any required supporting documentation, such as medical records, referral forms, or prior authorization documents, as necessary. These documents help validate the services provided and support the claim's accuracy.
9. Review the completed form thoroughly, ensuring that all information is accurate and legible. Any mistakes or missing information could delay the processing of the claim.
10. Finally, sign and date the form to acknowledge the accuracy of the information provided. Send the completed form, along with any supporting documentation, to the appropriate insurance company or payer using the designated submission method.

Who needs the 837 professionalcms-1500 claim form:

1. Healthcare providers: This form is primarily used by healthcare providers, including doctors, dentists, therapists, and other medical professionals, to submit claims for reimbursement of services provided to patients. It serves as a standardized document to communicate the necessary information to insurance companies or payers.
2. Insurance companies: The 837 professionalcms-1500 claim form is also relevant to insurance companies or payers. They require this form to process and evaluate the claims submitted by healthcare providers and determine the reimbursement amounts.
3. Patients: Although patients are not the primary users of the 837 professionalcms-1500 claim form, they may need to be aware of its existence and purpose. Patients should be informed about their healthcare provider's use of this form and understand the information required to accurately process their claims with the insurance company.

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What is 837 professionalcms-1500 claim form?

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

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

Healthcare professionals and facilities who provide medical services and submit claims to insurance companies or government healthcare programs are required to file 837 professionalcms-1500 claim form.

How to fill out 837 professionalcms-1500 claim form?

To fill out 837 professionalcms-1500 claim form, you need to provide information about the patient, the healthcare provider, the services provided, and the billing details.

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

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

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

Information such as patient demographics, healthcare provider information, diagnosis and treatment codes, dates of service, and billing information must be reported on 837 professionalcms-1500 claim form.