In which of the following situation would a CMS 1500 claim form be used?
The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of …
What is the latest version of CMS 1500?
02/12
The NUCC has recently changed the Form CMS-1500, and the revised form received OMB approval on June 10, 2013. The revised form is version 02/12, OMB control number 0938-1197. The revised form will replace the previous version of the form 08/05, OMB control number 0938-0999.
What goes in box 17a on CMS 1500?
Box 17a is the non-NPI ID of the referring provider and is a unique identifier or a taxonomy code. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a. 0B – State License Number.
What is the field 13 in CMS 1500?
Box 13 is the “authorization of payment of medical benefits to the provider of service.” If this box is completed, the patient is indicating that they want any payments for the services being billed to be sent directly to the provider.
What is the field 12 in CMS 1500 claim form?
Additional Explanation 12 Patient’s or Authorized Person’s Signature Yes Enter the patient’s or authorized person’s signature. Signature on File or “SOF” are acceptable. If the claim is for a Lab or DME provider “No Signature on File” or “Patient Not Present are also acceptable.”
What is the filing period for the CMS 1500 claim form?
within one year
Claims must be submitted within one year from the date of service and Medicare beneficiaries cannot be charged for completing or filing a claim. Offenders may be subject to penalty for violations.
What is the difference between a CMS 1500 form and UB 04 form?
The UB-04 (CMS 1450) is a claim form used by hospitals, nursing facilities, in-patient, and other facility providers. On the other hand, the HCFA-1500 (CMS 1500) is a medical claim form employed by individual doctors & practices, nurses, and professionals, including therapists, chiropractors, and out-patient clinics.
What is Block No 22 in a CMS 1500 form?
Complete box 22 (Resubmission Code) to include a 7 (the “Replace” billing code) to notify us of a corrected or replacement claim, or insert an 8 (the “Void” billing code) to let us know you are voiding a previously submitted claim.
What does the box 13 in CMS 1500 form represent?