CMS-1500

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CMS-1500

The uniform professional health care insurance claim form in the U.S. Previously known as the HCFA-1500 claim form.
Synonym(s): HCFA-1500, Health Insurance Claim Form.
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* Integrated solution supports HCFA-1500 and UB-04 claims
Replacing manual data entry of standardized healthcare information forms such as HCFA-1500 and UB-92 with paper-to-digital processing, it automates the management of forms and documents to improve medical claims' throughput and productivity rates.
Anthony Senagore, a Cleveland surgeon, had one more request: "Make it a simple form--no HCFA-1500," he said.
He noted that the types of things likely to be included in the documentation criteria include "all the information used in an HCFA-1500 [Health Care Financing Administration] form when claims are submitted, such as the patient's name, provider's name, CPT code and the DSM or ICD-9 code, and one or two additional elements which we're still discussing."
Medicare & Medicaid URL Description Addresses www.xact.org/professionals/ Web site to obtain HCFA-855, enrollment.shtml HCFA-855C, HCFA 855R forms www.hcfa.gov/medicare/ Web site for intermediary-carrier incardir.htm directory by state www.hcfa.gov/medicaid/obs5.htm Web sites for state-by-state www.hcfa.gov/medicaid/ hotline numbers mcontract.htm www.cpg.mcw.edu/www/upin.html Web site for unique physician identifier number (UPIN) database to search by state www.hcfa.gov/Medicare/edi/ Web site for HCFA-1500 completion edi5htm#FormHCFA-1500 guidelines www.hcfa.gov/medicaid/ Web site with list and definition bbadedef.htm of dual eligibility Table 2.
In defining service measures, data from UB92 claim forms, which are typically used to bill for institutional services, were combined with data from HCFA-1500 forms, which are typically used to bill for non-institutional services.
The solution supports both HCFA-1500 and UB-04 Claims on a single product.
There also is no way to code multiaxial diagnoses on the HCFA-1500.
Processing time for HCFA-1500 forms (an industry-standard claim submission form) took about a week.
In addition to the standardization that will probably result from the McData effort, several States and HCFA have built on the efforts of the National Uniform Claim Form Committee, which developed the HCFA-1500 billing form for ambulatory services, and the National Uniform Billing Committee, which developed the UB92 hospital billing form, as well as the American National Standards Institute (ANSI), which has developed standards for electronic submission of the HCFA-1500 and UB92 forms.
While it would be an uphill battle to redesign the HCFA-1500 or UB-92, there are plenty of forms that enter the claims processing paper stream that can be redesigned.
It also supports ANSI X12 and HCFA-1500 standards created specifically for the healthcare industry.