Title: Reading: (CU3 M1) Completing a CMS 1500 Form
Course: SkillsCom CRS 110 14.0 > Section: Credit Unit 3 Module 1

The CMS 1500 Claim Form is the standardized form used by most providers who are seeking reimbursements from Medicare. The CMS-1500 claim form also tends to be the standard insurance form used by all government and most commercial insurance payers. It is important to understand that this form and any form used to bill insurance either manually or electronically, must be completed accurately and in the proper format.

There are so many entries that it is easy, even for the seasoned insurance claims expert, to make a mistake in form or format.

Although this is not specifically true, think of the processors on the other end as just looking for a reason to deny your claim.

Also, remember that 90% of the processing is completed by computers, scanners, and software applications. They have no judgement or filter; they will just kick out anything that is not perfectly submitted.

It is pertinent to note that Medicare healthcare providers are waived under the Administrative Simplification Compliance Act from being required to fill electronic claims.  However, you will find that most initial claims, today, are filed electronically.  Electronic submissions utilize and require the same box by box information that is on the hard copy CMS 1500.  Therefore, in order for us to learn what must be submitted to file an insurance claim, we will go back to the basics and learn this form and format.

Check out the Instruction Manual and the actual form:

- Medicare Claims Processing Manual. (Webpage)
  - This is the "How-To" instruction manual
- New CMS 1500 (PDF Download)