Health Insurance Claim Form 1500 Instructions

Video Tutorial How to Fill Out Health Insurance Claim Form 1500 Instructions

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Questions & answers

Billing Provider Information & Phone Number – name, address, and phone number of provider requesting to be paid for services rendered. Billing provider address on both a CMS 1500 and UB must be the physical location. not a PO Box.
2. * Patient's Name Enter last name, first name, middle initial in this order as it appears on the patient's ID card. 3. Patient's Birth Date Enter month, day, and year of birth.
What three items do you need in order to fill out the CMS 1500? Patients registration form, patient's health record Documentation, superbill/encounter form.
Common Mistakes on the CMS 1500 Claim Form Mistake 1: Using an Outdated Form. Mistake 2: Diagnosis Code Isn't Specific Enough. Mistake 3: CPT Code Isn't Accurate. Mistake 4: Misusing CPT Codes. Mistake 5: Claim Wasn't Filed on Time. Mistake 6: Claim is Missing Information or Using Inaccurate Information.
Box 19 is commonly used on paper claims for data not otherwise accommodated by the CMS-1500 claim form. Data entered in this field will print but will NOT export electronically. Please contact your payer to determine where the data is expected.
How to fill out a CMS-1500 form The type of insurance and the insured's ID number. The patient's full name. The patient's date of birth. The insured's full name, if applicable. The patient's address. The patient's relationship to the insured, if applicable. The insured's address, if applicable. Field reserved for NUCC use.