CMS-1500 Form Software

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The CMS-1500 claim form answers the needs of many health insurers. It is the basic form used in the Medicare program for claims from physicians, other providers and suppliers, except for ambulance services. It has also been adopted by the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) and has received the approval of the American Medical Association (AMA) Council on Medical Services.

The CMS-1500 has space for providers and suppliers to provide information about other health insurance. Medicare uses this information to determine whether the patient has other coverage that is primary to Medicare, or if there is a Medigap policy under which payments are made to a participating physician or supplier.

CMS requires carriers to process "clean" claims within a designated time period. A "clean" claim is a claim that requires no outside request for additional information. Medicare must wait 13 days after receipt to process "clean" electronic claims and 27 days after receipt to process "clean" paper claims. If a "clean" claim is not processed within 30 days, Medicare will pay interest on the claim.

Note: You must submit original "Red" CMS1500 forms to Medicare Services. Photocopies or computer-generated forms will not be accepted.

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