What I Need to Know
How to Complete a CMS 1500 Form

Since every carrier is different the "required" or "optional" information could vary. What one carrier uses as required, another carrier may deem optional.

Keep a cheat sheet of requirements by carrier. When in doubt, almost every carrier has a billing manual online that can guide you through the process.

Version 2/12 of the CMS 1500 form is the only version that health carries will now accept.

CMS 1500 is the paper version and 837P is the electronic version of the form.

Health carriers are very particular about how this from is completed but over the years I have developed my own “standard” way to bill paper and electronic claims:

PAPER CLAIMS

  • The ink must be dark enough to be visible after scanning – refresh all old printer cartridges.
  • No hand written fields (other than a signature in box 31)
  • Keep within the fields.
  • No blue or red or colored ink.
  • All data must fit squarely in each field.  
  • Be careful with your fonts – Times New Roman seems to be the preferred font.
  • No mixed fonts - Italicized, bold, small text, large text, caps, etc  - stick with one for the full form
  • No special characters – dashes, hypens, number signs etc.
  • No more than 3-4 in one envelope when mailing.
  • No staples
  • ICD indicator (field 21) must be 9 for ICD-9 and 0 for ICD-10

ELECTRONIC

  • The patient name must match the patient name on the ID card exactly. For example, Elizabeth on the ID card but claim is billed as Beth.
  • The patient and insured dates of birth, sex, and ID numbers must be the same information that is on file with the health carrier.
  • The NPI must match the provider.
  • Referring/ordering provider is mandatory for certain services.
  • The zip codes must be correct (this is a new reason for rejection).

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