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PDF Editor FAQ

Is there an electronic version of the CMS-1500 form?

Yes, there is an electronic version of the CMS-1500 form.Most providers use software to submit the information included in the CMS-1500 electronically to payers. A smaller number of providers, and sometimes patients themselves, submit the CMS-1500 form on paper. The most effective way to do so is with a Fillable PDF or web-based version of the form. You can type into it and then print it and send it by mail to the payer.When preparing a paper-based CMS 1500, be certain to follow the privacy and security regulations outlined by HIPAA*. If you are using online software to type in and fill the form, be sure it is HIPAA compliant and secures the patient’s Protected Health Information (PHI). Providers are advised to have a Business Associates Agreement (BAA) in place with the company providing the online software. The fillable CMS 1500 PDF provided by Fiachra Forms allows you to type and fill the form on your own computer, so there is no need to use outside services or to trust your patient’s information to the internet.*HIPAA is the Health Insurance Portability and Accountability Act, a US law designed to protect patients' medical records and other health information.

What are the important aspects in filling out a CMS-1500 paying special attention to issues?

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.

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