Health Insurance Claim Forms Cms-1500 & Ub-04: Fill & Download for Free

The CMS-1500 - otherwise known as the HCFA - is the basic form to file an health insurance claim. If you don’t know how to fill one out, you really have no business working in medical billing.

Electronicclaim: Electronic Data Interchange (EDI) is the exchange of business transactions in a standardized format from one computer to another. It helps its clients and providers to use this technology to communicate claims,electronic remittance, claims payment, eligibility, and other information,providing a paperless and efficient process. E electronic Remittance Advice (ERA). These features streamline claim processing, reduce administrative work and improve problems.ERA files give providers details regarding multiple claims. ERA improves providers’ business office workflow by allowing the adjudicated claim information to be automatically posted to accounts receivable systems.Paperclaim:Although paper claims can be a nightmare to keep clean in medical billing, they are necessary at times. When you have to submit a claim on paper, follow these guidelines: Use only original claim forms (the ones printed in red). The current acceptable forms are the CMS-1500 and theUB-04.Important things to know about submitting paper claims:Professional provider claims must be submitted on the 1500 claim form.Facility claims must be submitted on a UB-04 claim form.If the patient has other health insurance (OHI) you must include the OHI Explanation of Benefits.Click the link to read more about electronic/paperclaim submission

Here are the important items to keep in mind when filling out the CMS 1500 as a paper claim form:IT MUST BE TYPED: The most important thing to know is that the form can no longer be hand written, and your claim will be rejected if your typed contents overlap with the red portions of the form. This is because health insurance payers use optical character recognition technology (OCR) to read and process claims.SOFTWARE IS RECOMMENDED: Your odds of getting your claim approved are greatly increased if you use a specially-designed template like the fillable PDF offered by Fiachra Forms: CMS 1500 PDF Template – Type, Print and Save to your Computer . This form has the added benefit (if you have a color printer) that it will print the red claim form in addition to your typed-in field information. An affordable one-time purchase allows you to type and print unlimited numbers of claims.AVOID THESE COMMON ERRORS:Patient Information:Missing or invalid subscriber’s name and/or birth date.Missing or incomplete name, address, and identifier of an ordering provider, rendering, or referring provider (or others).Provider Information:Invalid provider NPI identifier (when needed) for rendering providers, referring providers or others.Missing or incomplete service facility name, address, and identification for services rendered outside the office or home, including invalid ZIP codes or two-letter state abbreviations.Insurance Claim Information:Missing “insurance type code” for secondary coverage. This information, such as a spouse’s payer, is important for filing primary claims in addition to secondary claims.Pre-authorization codes missing.Missing payer name and/or payer identifier – this is required for both primary and secondary payers.Invalid diagnostic and/or procedure code(s).Missing or invalid admission date for inpatient services.Process-Related:Failing to include necessary documentation when needed.Filing the claim after the deadline date.