CMS Claim form Generation and Submission

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CMS Claim Form

Generation and Submission

Medical Administration Principles

Donna Corcoran

CMS Claim Form

Generation and Submission

The CMS-1500 claim form, (formerly called the HCFA-1500) was originally implemented by the Healthcare Financing Administration (HCFA), now called Centers for Medicaid and Medicare Services.

This form must be used when submitting claims to Medicare and Medicaid. The Centers for Medicare & Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), was created in 1977 ( to combine the synchronization of Medicare and Medicaid. The CMS uses a small part of the US budget to manage the two programs, which insure millions of Americans.

To generate a CMS-1500 claim form, the billing specialist must collect detailed information from not only the patient, but also the physician. Information needed to complete a CMS-1500 form is as includes all information regarding the patient.

Patients Name (Last, First, Middle Initial)

Home Address and Phone Number

Employer, Address and Phone Number

Date of Birth


Social Security Number

Referring Providers Name

Spouse's Name, Occupation, and Place of Employment

Emergency Contact Information

Health Insurance Information

(Understanding Health Insurance, pg. 60)

The billing specialist also must collect information from the physician, regarding, diagnoses and treatment.

Proper codes must be assigned and entered in the proper blocks on the insurance form. The CMS-1500 form must include all charges and total charges billed. Correct modifiers must be used when detailing an office visit, ER visit, etc. You must be sure the form has been signed, or "SOF" (signature on file) is input, the referring physician information is entered, and the EIN and provider numbers are also entered.

Most of this information can be obtained from the encounter form, but sometimes it may be incorrect or missing. It is important to have all...