How to File CMS 1500 Claims

With a few exceptions, most health care claims are now filed electronically, in the Accredited Standards Committee (ASC) X12N 837 Professional format. The alternative filing method is the Form CMS-1500, a paper form which is submitted, read using optical character recognition (OCR) equipment, and processed. The Form CMS-1500 can be used to file claims with Medicare carriers, Durable Medical Equipment Medicare Administrative Contractors (DME-MAC) and Part A/B Medicare Administrative Contractors (A/B MAC).

Things You'll Need

• Form CMS-1500
• Black Ink Pen or Typewriter

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Instructions

• 1

  Verify you are eligible to file a Form CMS-1500. Health care providers must meet certain criteria in order to be approved to file Medicare claims on the Form CMS-1500. Most of the providers eligible to file paper claims have less than 10 full-time employees, or submit less than 10 claims per month. Roster billing of Medicare-covered inoculations can be submitted on Form CMS-1500, and some Medicare Demonstration Projects request paper processing. Health care providers or billing providers who are experiencing disruptions in computer services for more than 48 hours are also allowed to temporarily submit paper claims. In addition, all dental claims and all claims for treatment outside of the United States must be submitted on the Form CMS-1500.

• 2

  Ensure you have an approved form. Checking that you have a permissible Form CMS-1500 is important, because it is read electronically with OCR equipment. Forms may be purchased through authorized vendors across the country, and may be printed by other vendors as long as they are in "OCR red" ink and on approved paper stock.

• 3

  Complete all applicable sections of the form using black ink or a typewriter. Some medical coding knowledge is necessary on the Form CMS-1500, particularly sections 21 and 24. The patient or his representative should sign boxes 12 and 13, and the health care provider should sign box 31.

• 4

  Submit the Form CMS-1500 to the Medicare Carrier, or the A/B MAC or DME-MAC. All submissions must be original. Copies are not accepted. All claims filed through the Form CMS-1500 must be filed within one year from the date of the service rendered in order to be reimbursed. Form CMS-1500 filings with missing information may be returned for further completion. These forms must be resubmitted within the original one-year time limit in order to be paid.