HCFA 1500

HCFA 1500

Managed care The official standard form used by physicians and other providers when submitting bills/claims for reimbursement to Medicare or Medicaid for health services; it is also used by private insurers and managed care plans; HCFA 1500 contains Pt demographics, diagnostic codes, CPT/HCPCS codes, diagnosis codes, units. See Compliance, HCFA, Medicare, Red tape. Cf UB92.
References in periodicals archive ?
I recently received a letter from an insurance company advising me that, to process my client's injury claim, the insurer would "require UB-92 forms for hospital care and HCFA 1500 forms for any other medical care.
This is best illustrated with an example such as the US standard health claim form, the HCFA 1500.
UB-92 HCFA 1500, HCPCS, and Relative Values for Physicians from the Center for Medicare and Medicaid Services
The billing process begins with a download of data from the provider's information system, usually in the form of a print spool file containing the UB-92 or HCFA 1500 claims, and then the billing application analyzes each claim for completeness and accuracy of data.
Colleagues who have done this say they provide, as a service to the patient, a single bill on a HCFA 1500 form that the patient can submit to Medicare.
Effective, January 1, 1999, all claims submitted by NPs must include their name and UPIN on HCFA 1500 claim forms.
1, HCFA will require all claims to include the lab's CLIA number on HCFA 1500 forms as a condition of payment.
They also can be used to capture HCFA 1500 and UB-92 health claims and unstructured documents such as invoices, freight bills and Explanations of Benefits.
The forms function can be used to allow providers to submit claims in standard HCFA 1500 format by the WWW server and, with sufficient security protection, even schedule hospital facilities for procedures on patients and order medications with an on-line signature.
It is available in three versions: Standard Module that provides full bill capture of field data from HCFA 1500 and UB92 forms; Advanced Module that adds sophisticated form rules to the Standard Module; and the Premium Module that adds intelligent database hook-up capabilities to the Advance Module.
In cases where therapy had already been administered or initiated, the actual HCFA 1500 and UB 282 forms submitted for payment by the home care providers were evaluated by one or more members of a multidisciplinary team consisting of a doctor of pharmacy, a clinical pharmacist, a home care nurse, a metabolic nutrition specialist, a claims analyst, a reimbursement specialist, and a physician.