If you’ve gone through the process of becoming an in-network provider with a number of insurance companies, then the next step is to learn how to bill insurance payers for your services. While there is a learning curve to insurance billing, the first step to filing an insurance claim starts with a CMS 1500.
In this post we’ll cover what CMS 1500 form basics: what it is, how to fill one out, and how to file it.
What is a CMS 1500?
The CMS 1500 is a health 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. Every single insurance payer, private and federal, requires a CMS 1500 form to be properly completed in order to process the services you provided to your client. Think of it as a way to send an invoice for your services — once it is processed by the insurance payer, you’ll receive reimbursement for your services (if the claim is approved).
You fill out a CMS 1500 each time you wish to submit a claim.
Below is an example of a CMS 1500 claim form. If you are sending the claim form in via mail, then you must use forms that have been printed in red ink.
With that being said, most wellness professionals choose the convenience of submitting their claims electronically. E-filing ensures claims are received, and processed, in a more efficient manner, as well as enables better data/financial tracking of claims and payments.
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 quick task with our in-platform EHR and 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 typically will 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. 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.
If you don’t have a clearinghouse yet, here is a list of popular ones to help get your research started:
With your EHR platform, claim generation tool and clearinghouse in place, you’re ready to start submitting CMS 1500 claims to your insurance payer. Claims processing times depend on whether you’ve submitted electronically or via mail, and can vary among insurance companies. In general, your claim can be processed in as little as a few days, to as much as a few weeks.
Ready to learn more about insurance billing?
Download our free Healthie webinar on Insurance Billing for Dietitians
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