What is The CMS-1500 Claim Form and How to Use It

Even though many of the billing claims forms can be done via medical billing and coding software. Paper claims are still being used in a large number of medical offices worldwide.

The paper claim filing form is known as the CMS (Centers for Medicare and Medicaid Services) 1500. This is a universal form used by healthcare provides to submit their claims and invoices to insurance companies and carriers.

The forms are general red and white (like the sample form below) designed specifically by the Centers for Medicare and Medicaid Services (CMS). Below is a sample CMS claim form that you may see once you are on the job:

sample cms 1500 forumThe original forms was known as the HCFA (Health Care Finances Association) 1500 form, in 2007 the following changes were implemented to allow for the claims to be reported to the National Provider Identifier or NPI for short.

  • On the original HCFA form box allotted for reporting the NPI number was once one box that is now split into two separate boxes. The national provide identifier number now goes in the lower portion of the box with the other ID numbers entered in above the shaded area of the box.
  • The barcode that was located in the header is now removed so that there is more space allotted for entering in the payers address.
  • The “please do not staple” caution that was place in the header was also taken off. The Medicare office now asks that you place a single staple in the top center portion of the form.
  • Box 24C which was originally where you will fill out the type of service provided is now called “EMG”

As you will be told throughout the course of your classes is that these forms are very important and MUST be filled out completely and without errors. If the form is not completed correctly this can cause the claim to be denied. An example of this is, if you are filling out the form and you make a mistake by not placing the patients’ date of birth on the form this can cause the form to be denied. Many insurance agencies have a program in place that automatically scans the forms as they are sent in and if the important fields are not filled out correctly then it is an automatic denial and it will be stated that they were unable to confirm patient identification.

Box 12 and 13 Completion Tips

An often overlooked part of the CMS 1500 form is boxes 12 and 13. These are not overlooked in the sense that they are not filled out at all; they are boxes that are filled incorrectly due to the biller and coder not understanding why they need to be filled out in the first place.

Release of Information (Box 12)

A common mistakes made with box 12 include is that if information does not need to be release then the box does not have to be filled out. The release of information statement should have been signed by the patient upon arriving at the medical center. If you work for a medical billing agency then you would need to ask the provider to have their patient sign this form and not just place signature on file in box 12.

Authorization of Payment (Box 13)

When this box is filled the patient is stating that any money received for the providers’ services are sent directly to the provider. However, it should be noted that this does not mean that payment from the insurance provider will be sent to the provider, it just simply says that the patient has given permission for it to be done. So if the patient authorizes any and all payments to be made directly to the healthcare service provider then it is your job to ensure that this box is filled out.