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
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.
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
ink must be dark enough to be visible after scanning – refresh all old printer cartridges.
hand written fields (other than a signature in box 31)
- Keep within the fields.
blue or red or colored ink.
data must fit squarely in each field.
careful with your fonts – Times New Roman seems to be the preferred font.
mixed fonts - Italicized, bold, small text, large text, caps, etc - stick with one for the full form
special characters – dashes, hypens, number signs etc.
more than 3-4 in one envelope when mailing.
indicator (field 21) must be 9 for ICD-9 and 0 for ICD-10
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.
patient and insured dates of birth, sex, and ID numbers must be the same information
that is on file with the health carrier.
NPI must match the provider.
- Referring/ordering provider is mandatory for certain services.
zip codes must be correct (this is a
new reason for rejection).