CMS 1500 Form 02/12 Steve Verno, CMBSI, CMSCS, CEMCS
Disclaimer I am NOT a Lawyer! I DO NOT provide Legal Advice! I DO NOT answer, “Is It Legal?” questions I AM a Coder and Medical Biller! This presentation is for Training Purposes. The Information in this Presentation came from The National Uniform Claim Commission (NUCC) CMS 1500 Instruction Manual
What will NOT be discussed! Current or Past Claims Issues! Coding or Billing Problems You are Having! Legal Issues! Software problems! Rumors or Office Debates!
What WILL be discussed! Changes to the CMS 1500 Form! When it may be necessary to use a Paper CMS 1500 Form
The Court Ordered The Insurance Company to pay an old claim and* The original billing company is out of business
Boxes 1 through 13 are prepared based on information provided by the PATIENT/INSURED
Valid Condition Codes W2 Duplicate of original bill W3 Level 1 appeal W4 Level 2 appeal W5 Level 3 appeal
Boxes 14 through 33a/b are based on the patient encounter/visit/Provider Information