If you’ve gone through the long process of becoming an in-network provider with a number of insurance companies, then you can’t wait to put this new credentialing to use.
The first step to filing an insurance claim starts with a CMS 1500.
In this post we’ll cover what the form is, how to fill one out, and how to file it.
What is a CMS 1500?
The CMS 1500 is an insurance claim form for non-institutionalized healthcare providers, such as private practice nutrition and wellness professionals.
(If you come from a clinical background, then this form is like a UB-04.)
You fill out a CMS 1500 each time you wish to submit a claim.
Here is an example:
How to Fill Out a CMS 1500
The CMS 1500 requires the following information:
- Client Personal Information: This includes all the basics you would get on an intake form, such as name, date of birth, gender, address, and relationship to the Insured.
- Client Billing Information
- Referral Information: Some insurance companies require that you include any information about the referring provider, like their name NPI number.
- Your Provider Information: This includes your NPI, In-Network Provider ID, and additional information as required by individual company.
- Your practice’s information: You’ll need your location NPI and address.
- Insurance Policy Information
- Diagnosis: Make sure to include all appropriate CPT and ICD-10 codes!
Pro Tip: Healthie makes filling out CMS 1500’s a breeze with our in-platform CMS 1500 form creator. Ask for the information you need from your client during the intake form process and Healthie’s CMS 1500 creator will auto-fill each new form after the first time you’ve created it! Healthie’s forms are compatible with clearinghouses such as Office Ally to make filing a claim easier than ever.
How to File a CMS 1500
Once you have filled out your CMS 1500, you must submit it to a clearinghouse.
A clearinghouse is a third party company who handles your CMS 1500s and coordinates with the insurance company to pay for your services.
If you don’t have a clearinghouse yet, here is a list of 7 popular ones to help get your research started:
Clearinghouses are often digitized nowadays, and tend to act as a central way to keep track of your claims and update you on their status. With Healthie, you can note the status of a claim in our system to keep you in the loop!
Looking for more on private practice insurance? Let us know at firstname.lastname@example.org!