Form CMS-1500 is the standard paper claim form used to bill an insurance for rendered services and supplies. It provides information about the client, their corresponding insurance policy, and their diagnosis and treatment. Additionally, most insurances allow you to send an electronic version, called an 837 file.
The following basic questions are required for claim adjudication and are represented by various boxes on a CMS-1500 form:
|Who is being treated?||Client||2, 3, 5, & 6|
|What is the client's coverage?||Insurance Details||1, 1A, 4, 7, & 11|
|Who is providing services?||Rendering Provider||24J|
|Who should be reimbursed?||Billing Provider||33|
|Where was the treatment performed?||Place Code & Service Facility||24B & 32|
|When was the treatment?||Date of Service||24A|
|What is being treated?||Diagnosis Codes||21|
|What services were performed?||CPT Codes & Units||24D & 24G|
|What is the cost of services?||Charges||24F|
The top section of a CMS-1500 form provides information about the client, their insurance details, and the policy plan type.
The bottom section covers information about the clinic, the providers, the diagnosis, and the related treatment codes.