CMS 1500 Form: The Right Way to Do It

When medical providers need to submit their claims to the insurance agencies for their services, they are made in CMS 1500 form which is accepted universally.

These forms were previously known as HCFA 1500 forms and these HCFA 1500 forms didn’t contain the National Provider Identifier or NPI. These forms which are mainly printed in red and white are designed by Centers for Medicare and Medicaid Services.

There are a number of changes other than NPI, which has occurred on CMS 1500 form.

• The header is free from the barcode. This space is used to fill in the address information of the payer.
• From the header “please don’t staple in this area” was removed.
• Adding “Tricare” above the “Champus” is another important feature.
• From box 24C, “Type of service” is removed. “EMG” is the new name of this field.
• “Reserved for local use” a field in the old form was removed.
• The website of NUCC is also added in the new form.

While filling CMS 1500 form one should be very careful about giving out the details. If the form is inappropriately filled the claim will not be accepted by the insurance agency. Softwares have been introduced to make this filling process easier but it is very important how the data or information is fed to the software.

Different insurance companies have different requirements through these forms. The one who make the claim should provide the exact information required. These forms consist of boxes and information is put into this boxes. These forms are then verified by the assistance of computer programs.

Some wonder why their worthy claim got denied by the insurance provider. The answer is in the way the form has been filled out. The forms are scanned and fed into the software system in the PDF format. They are not even touched by human beings. Medical providers should keep utmost care when filling out essential details like patient’s name, date of birth and health issues.

When the required boxes are left blank, the scanner can’t recognize the form and eventually the form will get rejected. Every insurance agency has the correct date of birth of each patient. When the medical provider fills in the wrong date of birth, it will also leads to the denial of the form.

The data processing process is completely done by computer softwares and they don’t have ‘common sense’ as we possess to weed out the irrelevant information. It works on the data fed by the forms and if anything went wrong, the form or claim is rejected completely. It would be better if you go for an expert advice in filling the form. It will only help to give your form a relevant and informative one.

The denial of many claims is mainly due to the improper submission of the CMS 1500 forms. Forms which are improperly filled and also giving out misleading information will invite rejection by the insurance agencies. Always take time to give out exact information. This will make a good difference in making your claim.

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