Properly Completed 1500 Claim forms:
Here are several completed claim forms that I have learned to properly fill out in my Medical Insurance, Billing and Coding class. I've learned that the 1500 Claim form is probably the most important form that is used by a medical biller and coder. Here are some important tips to always remember when filling out the form:
- Make sure the fields are properly aligned. Some practice management software may not line up the boxes properly which can lead to rejected claims. Check with your software vendor to make sure you have the latest CMS 1500 form.
- Use only black 10-point plain font without any effects such as italics, script, or stylized fonts.
- Use only upper-case capital letters.
- Do not use dollar signs, decimals, or punctuation.
- Follow the correct Health Insurance Claim Number (HICN) format with no hyphens or dashes.. The alpha prefix or suffix is part of the HICN and should not be omitted.
- Make sure data is in the appropriate field and does not overlap into other fields.
- Use an individual’s name in the provider signature field - not a facility or practice name.
- Include all applicable NPIs on the claim. This includes the referring provider NPI.
- Include special certification numbers for services such as clinical laboratory (CLIA number) or mammography (FDA number).
- Don't staple, clip, or tape anything to the CMS 1500 form.
- Is free from tears, crumples, or excessive creases. Recommend submitting claims in a full letter size envelope.
- Clean and free from stains, handwritten notations, circles or scribbles, strike-overs, crossed-out information or white out.
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chapter_12_elsa_mooney_claim_form.pdf | |
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chapter_13_rose_clarkson_claim_form.pdf | |
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assignment_11_ch_14_rosa_sandoval_claim_form.docx | |
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ch_15_claim_form_glen.docx | |
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