Completing the CMS-1500

Many of the rejected and problem claims are due to incomplete or incorrect information on the CMS-1500, formerly known as the HCFA1500. It is important to thoroughly the complete the form paying particular attention to the following boxes that are often completed incorrectly.

1a.     Insured’s ID number
4. Insured’s name
8. Full-time student (if appropriate & child is 18 or over)
9a-d. Other insurance information (if applicable)
10a-c. Patient’s condition related to: (extremely important)
11. Insured’s policy group or FECA # (see ID card)
11a. Insured’s date of birth & sex
11b. Employer name (see ID card)
11c. Insurance Plan Name (list PPO network name listed the ID card)
14. Date of Current illness or injury
31. Provider’s name (this should be a signature)
32. Name & address of facility (put office address here)
33. Physician’s suppliers billing name (we will replace your information in this field with the AHC information)

This list is not comprehensive, but these are the fields that are often left blank or completed incorrectly. Become familiar with the form and the process your office follows for completing it. If the form is not completed it will either slow down the claims process or result in the claim being denied by the insurance payor.

There are several reasons why a claim payment might be delayed.

  • There is incorrect or incomplete information on the CMS-1500.

  • The claim is for a new patient and is submitted without a copy of their insurance card. Attach a copy of the insurance card for all new patients.

  • The patient has primary insurance through another company. The primary coverage EOB is needed before payment can be made.

  • The claim is mailed to the wrong address. Be sure to send claims for current contracted networks to our office, unless stated otherwise.

  • If box 8, accident details, is not complete, the insurance company must ask for further information, slowing down the claim payment.