The CMS-1500 form is the standard form used when submitting claims via mail. Because some insurance companies are behind the times, or they require things that we do not have, we will need to send the insurance company a CMS-1500 form for them to process payment. Look below at how to complete this form, and please note that depending upon the insurance will determine how it is filled out.

 

 

📚Resources Needed

 

 

🚀 Tips & Tricks

  • Details Matter!
     
  • Review various videos on how to properly complete the form. This is a good one to start with. 
     
  • Complete form in all CAPS
     
  • Medicare, UMR, and Cigna all require claim submissions via CMS-1500 form. 
     
  • Always view Patient eligibility prior to filling out the CMS 1500 form. Also, review any notes we may have made in the EHR. This may help to prevent a denial. 
     
  • Always check your work!


     

📘 Instructions

Make sure not to forget one of these steps. 

  1. Pull up the Patient Billing Page and look at what visits need claims submitted for that day. 



     
  2. Pull up the EHR Billing page and filter the results to the specific day you’re working on.



     
  3. Before submitting a Claim, run an eligibility check for the Patient. This will help to streamline the Patient. Also, check their insurance demographics to see if there are any notes regarding their coverage. 

    ⚠️For Medicare, we just use their insurance card. UMR and Cigna have portals you can check. 

     
  4. Once you have all the information, pull up the CMS-1500 form. 

     
  5. From the Patient billing spreadsheet, click on the encounter number and open the link to access the encounter note.

     

     
  6. You should now be able to see the encounter note with the dx codes there at the bottom of the canvas. 

     
  7. From the EHR Billing page, click on the action icon in the far right of the row and select Generate Claim. 



     
  8. The claim form will now open up and you can see some of the details related to the encounter. You can also add items which is what we will be doing. 

     
  9. Follow the steps necessary to complete the form. I will add more to this is you don’t understand how. 

     
  10. Download the claim and save it as the encounter number. Example: Encounter 00401-CMS1500


     
  11. Upload the claim file to the Claim Submissions folder and copy the file link. 


     
  12. In the Patient billing spreadsheet, complete the row with the information you have from the claim. Add the following information: 
    1. Status = Submitted
    2. Add Claim File Link
    3. Submission Type = Mailed CMS-1500
    4. Price 


       
  13. Go back to the EHR billing page and add the following information: 
    1. Upload Claim File
    2.  Submission Type = Mailed CMS-1500
    3. Save


      ⚠️You will know it is submitted by, if you click on the action icon for the encounter row - you will no longer see the Generate Claim option. 


       
  14. Send a message to Matthew with the link to the completed CMS-1500 form so he can print it out and mail it. 

     
  15. Always double check to make sure everything is good. If it is, move on to the next!

     

Here is a video to help you out. 

  1. Fill Out CMS1500 #1.mp4
  2. Fill Out CMS1500 #2.mp4
  3. Fill Out CMS1500 #3.mp4