CMS 1500 Claim Form

Satisfactory Essays

I. The CMS 1500 Claim Form A. Format of the Form
• What is a CMS 1500 Form?
• Parts of the 1500 Form
• Why is the CMS 1500 Form used?
• What information is needed?
• Who Uses the Paper CMS-1500 Form?

II. Documents Needed When Completing the CMS-1500 Claim Form
A. Patient Information Form
• New Patient Information
• Insurance Section
• Additional Insurance
• Insurance Authorization and Assignment B. Patient Insurance Identification Number C. Patient Health Record D. Encounter Form
III. Completing the CMS-1500 Form
• Patient/Insured Section
Physician/Supplier Section
IV. The Three Sections of the CMS 1500 to Fill
• Parts 1-13 (Patient Information)
• Parts 14-24 (Procedural and Diagnostic Information)
• Parts

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