What’s a CMS 1500 and What Can it Do for My Practice?

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:

  1.  MedX12
  2. Office Ally
  3. Envoy from WebMD
  4. ZirMED
  5. E Claims
  6. McKesson HBOC Clearhinghouse
  7. Payerpath

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 hello@gethealthie.com!

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