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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.

Medical claim forms as paper submissions

Medical practices must submit full, accurate information to receive payment from insurance providers. The 1500 form captures all the information that HCFA requires to assess reimbursements administered under the Centers for Medicare and Medicaid Services (CMS). HCFA 1500 forms also contain the data points that private insurers need for assessing reimbursements. Practice personnel may hand-print the information in dark ink or use a non-italic, black 10- or 12-point font on a dot matrix or laser printer.

The color format of HCFA 1500 forms

This medical claim form is just one page. Like many tax forms that the IRS requires for specific paper filing, the 1500 form has red ink on white paper to enable the CMS to scan it for computer data entry. Medical practices may also use only the red-ink copy as the original.

Some of the information on medical claim forms

If a medical practice does use the correct medical claim form or if it doesn’t complete the paperwork strictly according to guidelines, the CMS won’t process the form for government reimbursement. Private insurers may also deny the form and make the reimbursement process more difficult. Some of the information requirements are the following:

  • Patient’s name and Medicare number exactly as they appear on the Medicare card
  • Full, 10-digit Provider Identification Number of the practice, including the National Provider Identifier (NPI) for any referring provider
  • Valid address and ZIP code for the location of the service provided, not a P.O. box or “Same as Above”
  • Exact certification number for the service provided and any clinical laboratory participating in the service
  • Strict compatibility between units/days of service provided and the quantity/date of service

Confidentiality of the 1500 form

Data privacy provisions under HIPAA require that patient identities remain confidential. Medical practices that make copies of the 1500 claim form must file the copies where unauthorized personnel cannot access them. Use confidential folders like those that companies use to separate employees’ medical records from their personnel records. These serve as record-keeping safeguards for adhering to legal standards for patient privacy.

Cost-saving 1500 form packages

Like the large number of HR forms that private companies must have for employees, a medical practice must have plenty of documents for its patients, including those for submitting claims. Authorized 1500 form printers like ComplyRight™ provide cost-saving packages ranging from 250 to 1,000 and 2,500 forms.

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