The CMS 1500: Health Care Advantage

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CMS 1500 is a paper claim form that is a used by healthcare providers in order to submit claims and invoices to insurance carriers in order to receive payments for services provided to a patient. Before CMS -1500 was formed according to In 1975 the American Medical Association (AMA) approved a universal claim form called Health care financing Administration also known as HCFA-1500. During the transition of HCFA-1500 AMA joined forces with the Centers for Medicare and Medicaid Services (CMS) to form a Uniform Claim Task Force to promote and standardize the use of the universal health claim form, which was later replaced by the National Uniform Claim Committee (NUCC). In 2001 the HCFA-1500 become known as the CMS 1500 when Health Care financing …show more content…
Example of a clean claims is when a primary carrier explains benefits for services correctly on forms, and uses appropriate code when submitting a claim. Rejected claims in the other hand is a claim submitted electronically missing valid information by the payer. Example of a rejected claims is when a claim was not submitted in timely manner by a staff member, which can cause a claim to be rejected. Incomplete claim is missing the National Provider Identifier (NPI), ID like ordering physician. Invalid claim is a claim that contains information, but is illogical incorrect. Example of an invalid claim is when a medical office list incorrect provider number of referring doctor. Dirty claim is a claim that has errors, because a medical office provides inaccurate revenue codes when filing a claim. Delete claim is a claim that is canceled or voided by Medicare fiscal intermediary an example of a delete claim is when a CMS 1500 02/12 claim is missing demographic information like a patient’s age or …show more content…
The first line which is line 1 and line 1a should have insurance information like Medicare Tricare if applicable to patient. Line 2, 3, and 5 should have a patients demographics such as name, age, race, gender and address, while line 4, 6, 9, 11 a, c, d should have insured patient’s insurance information like group number while line 10 should have a patient’s employment status while line 12 and 13 is a patient’s authorization which is their signature. The bottom portion of the CMS 1500 02/12 claims form is the clinical portion. Block 21 is the diagnostic codes for a patient’s condition, while Block 24 is date of services and prices for services. Block 25 is the Employer identification number (EIN) which is a federal tax ID. For placement of the NPI number a biller should refer to block 17a, 17b, and 24, when ordering and supervising doctors are different individuals. The ordering doctor should be in Block 17 with NPI number going in Block 17b, the NPI of supervising doctor goes in Block24j and supervising physician goes in Block 31 and group NPI in Block 33a. Once all of these blocks and lines are filled a biller should double check documentation, like insurance subscriber numbers, , copay amounts, point of contact details of visit, appropriate CPT codes for services provided, use all upper case letters on form and don’t use symbols like N/A

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