Directions for Form HCFA-1500
The HCFA-1500 form, now known as the CMS 1500, is a health insurance claim form. It is necessary to fill out these forms accurately as any mistake or gap in the form can result in insurance delays or total cancellation of claims. Once you have all the data needed to fill out the form, transfer the information into the form in the correct places.
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Instructions
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Download a copy of the HCFA-1500 claim form. (See References.)
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Look carefully into the patient's medical record and enter the details correctly. Select the insurance company's name from the top left corner. Then insert the insured person's identification number in box "1A." If you aren't sure of the number, check with the hospital or medical facility where the treatment was received.
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Fill in the patient's name, address, gender and relationship with the insured. Add the type of insurance plan --- HMO, PPO or POS. Complete this section by filling in the marital status and details of employment.
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Check "Yes" or "No" to answer whether the patient's medical condition is due to an accident or any incident related to his or her employment. Then, ask the patient to sign the form.
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Enter the name of the doctor and a federal tax identification number. Have the doctor sign in box 31. Also, enter the prior authorization number (the number obtained before the treatment commences by calling the number on an insurance card).
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Fill in details regarding the duration of the treatment, the costs and the place where the patient was treated. Also fill in the total amount due. This will only be paid after the benefit policies are coordinated.
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Write down the billing address of the provider if it's not the same place where the treatment was received. If they both are identical, write "same."
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Tips & Warnings
Do not enter any incorrect information. If you are not sure of something, verify the details from the medical records. You could also call the insurance company or the hospital if you need any assistance.
