Medical practices submit medical claim forms to insurance providers to receive payment for care rendered to insured patients. Practices submit most claims electronically, but also use paper forms as well. Regulations mandate that practices use CMS 1500 forms as the paper documents for submission to government insurers. The forms are also the standard document for private insurance submissions.
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Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
This form was revised to align the paper form with some of the changes in the electronic healthcare claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
The most significant change was the addition of 8 diagnosis codes in field 21
Includes employment history, references, education, personal information, physical record, check-offs for special questions and space for interviewer's remarks
Organizer with FMLA Flow Chart (1): Easy-storage organizer featuring FMLA-administration flowchart, clearly outlining each step of managing FMLA request
Mandatory Employee Notice (10): Provides accurate information to employees as required by law, explanation of reasons for taking leave and employee responsibilities, rights and benefits
Employee FMLA Leave Request Form (10): Gathers the necessary information to determine an employee's FMLA eligibility without violating privacy laws
Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
This form was revised to align the paper form with some of the changes in the electronic health care claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
The most significant change was the addition of 8 diagnosis codes in field 21
Eliminates the need for multiple warning slips, saving time and paper
Encourages employee accountability by showing employees you are serious, but are willing to give them an opportunity to correct problems
Provides a space for employees to sign the Warning Notice, indicating that they understand the warning and the consequences if their performance does not improve