What is CMS 1500 Claim Form?

Claim Form CMS  :

In the 1960s there were a number of different claim forms and coding systems required by third-party payers to communicate information regarding procedures and services to agencies concerned with insurance claims. However, there was no standardized form for physicians and other health care providers to report health care services. Therefore, the American Medical Association (AMA) embraced an assignment in the 1980s to work with the Centers for Medicare & Medicaid Services (CMS; formerly known as HCFA), and many other payer organizations through a group called the Uniform Claim Form Task Force to standardize and promote the use of a universal health claim form.

Although many providers now submit electronic claims, many of their software/hardware systems depend on the existing 1500 Claim Form in its current image. Minor changes have been made to the form in order to accommodate the National Provider Identifier (NPI) as well as other identifiers.

The 1500 Health Insurance Claim Form answers the needs of many health payers. It is the basic paper claim form prescribed by many health plans for claims submitted by physicians and suppliers, and in some cases, for ambulance services.

Concepts of Insurance Company (Medical Billing)

1.  Traditional

  i. Basic Coverage  (In-patient service)

  Its covered technical components

  ii. Major Medical Plan (Out-patient service)

  Its covered professional component

  iii. Comprehensive Coverage (both In & Out patient service)

2.  Managed Care

HMO (Health Maintenance Organization)

POS (Point of Service)

PPO (Preferred  Provider Organization)

EPO (Exclusive Provider Organization)

Concepts of Insurance Company

1.  Traditional

  i. Basic Coverage (In-patient service)   
  It Covers technical components
  ii. Major Medical Plan (Out-patient service)

  It Covers professional component
  iii. Comprehensive Coverage (both In & Out patient service)

2.  Managed Care

HMO (Health Maintenance Organization) Patient must meet PCP. Then he will refer to a specialist. Referral Authorization Number is essential.

POS (Point of Service) After meeting the PCP Patient can choose specialist from the list of providers . Out of Network Providers Covered.

PPO (Preferred  Provider Organization) Directly patient can go to the specialist. Out of Network Providers Not Covered.

EPO (Exclusive Provider Organization) Except Emergency Cases Out of Network Providers Not Covered.