Health Insurance Claim Form 1500 Instructions

The nucc has developed this general instructions document for completing the 1500claim form.

Health insurance claim form 1500 instructions. Instructions for completing the cms 1500 claim form. Any user of this document should refer to the most current federal state or other payer instructions for specific requirements applicable to using the 1500 claim form. The purpose of this manual is to help standardize nationally the manner in which the form is being completed. 1500 claim form reference instruction manual.

The nucc has developed a 1500 reference instruction manual detailing how to complete the claim form. A federal government website managed and paid for by the u s. The 1500 health insurance claim form 1500 claim form is in the public domain. The center of medicaid and medicare services cms form 1500 must be used to bill sfhp for medical services.

For further information contact owcp. It is the basic paper claim form prescribed by many health plans for claims submitted by physicians and suppliers and in some cases for ambulance services. 7500 security boulevard baltimore md 21244. Instructions on how to fill out the cms 1500 form item instructions item 1 type of health insurance coverage applicable to the claim show the type of health insurance coverage applicable to this claim by checking the appropriate box e g if a medicare claim is being filed check the medicare box.

The current version of the instructions for the 02 12 1500 claim form was released in july 2020. A brief description of each data element and its applicability to requirements under feca blba and eeoicpa are listed below. Centers for medicare medicaid services. Enter the patient s claim number.

The form is used by physicians and allied health professionals to submit claims for medical services. Enter the patient s last name first name middle initial. All items must be completed unless otherwise noted in these instructions. 1500 claim form instructions.

Instructions for completing the form.