How to Fill Out Pip Med HCFA Forms
An individual who wishes to pay for his medical expenses with applicable Medicare coverage provided by the U.S. government must submit the appropriate forms, such as HCFA 1500, to his insurance company. The insurance professional from the private insurance provider (PIP) will then fill out the HCFA medical forms. Unlike other methods of Medicare medical billing, HCFA forms combine the certification statements into a single bill.
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Instructions
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1
Fill out the first eight blocks of the HCFA form ascertaining the personal information of the patient in question. This includes all personally identifiable information (such as names, date of birth and address) as well as any extraneous information required to process the form. For example, if the patient is requesting medical coverage through the insurance plan of another individual, you must note the patient's relationship to the insured individual.
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2
Complete all of block 9 if the patient in question has medical coverage provided by insurance plans independent of the private insurance provider (PIP) to whom you are submitting the HCFA form. Skip this step if additional insurance coverage is not applicable to your patient. If you are unsure, consult the "Claims Processing and Payment" section of the HCFA Coordination of Benefits manual, available from your supervisor.
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3
Enter any details about the patient's current medical condition into block 10 of the form. Place a check into the boxes detailing whether the injury or medical situation was related to work or an automobile accident. This section provides information regarding the patient's original injury and its cause, helping the private insurance provider determine what other insurance (such as the patient's car insurance) can cover the current incident.
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4
Ask the patient in question to sign blocks 11 and 12. The HCFA form cannot be processed by the private insurance provider if the form does not carry the patient's signature.
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Enter any additional comments in block 19 that you feel is relevant to the medical case, but was not asked for in the previous sections.
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Complete the sections requesting information on the actual servicing of the patient (blocks 23-24). This includes any diagnosis provided by the medical expert involved in the case, as well as the length of time the patient was treated.
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7
Add all of the relevant financial data, including the balance owed by the patient, in blocks 25-30.
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8
Request that the medical expert involved in the case sign and complete blocks 31-32.
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9
Submit the form to the claims processing unit.
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