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What Is A CMS 1500: Understanding The CMS 1500 Form

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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.

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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:

What Is A CMS 1500: Understanding The CMS 1500 Form

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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.

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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 your EHR platform, claim generation tool and clearinghouse in place, you’re ready to start submitting CMS 1500 claims to your insurance payee.

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