Here are the important items to keep in mind when filling out the CMS 1500 as a paper claim form:
1) IT MUST BE TYPED
The most important thing to know is that the form can no longer be hand written, and your claim will be rejected if your typed contents overlap with the red portions of the form. This is because health insurance payers use optical character recognition technology (OCR) to read and process claims.
2) SOFTWARE IS RECOMMENDED
Your odds of getting your claim approved are greatly increased if you use a specially-designed template like the fillable PDF offered by Fiachra Forms: . This form has the added benefit (if you have a color printer) that it will print the red claim form in addition to your typed-in field information. An affordable one-time purchase allows you to type and print unlimited numbers of claims.
3) AVOID THESE COMMON ERRORS
- Patient Information:
- Missing or invalid subscriber’s name and/or birth date.
- Missing or incomplete name, address, and identifier of an ordering provider, rendering, or referring provider (or others).
- Provider Information:
- Invalid provider NPI identifier (when needed) for rendering providers, referring providers or others.
- Missing or incomplete service facility name, address, and identification for services rendered outside the office or home, including invalid ZIP codes or two-letter state abbreviations.
- Insurance Claim Information:
- Missing “insurance type code” for secondary coverage. This information, such as a spouse’s payer, is important for filing primary claims in addition to secondary claims.
- Pre-authorization codes missing.
- Missing payer name and/or payer identifier – this is required for both primary and secondary payers.
- Invalid diagnostic and/or procedure code(s).
- Missing or invalid admission date for inpatient services.
- Failing to include necessary documentation when needed.
- Filing the claim after the deadline date.
- Patient Information:
CMS 1500 Software & Template
If you do not have your own claims management software, use the CMS 1500 PDF to follow along as you read through the guide. You can download the fully functioning demo here, or purchase Fiachra's Fillable PDF claim form, and for a one-time fee you can type, print and save as many filled claim forms as you need.