Are you using the correct form when submitting your claims? This seems simple, but can be more complex than you think. Here is a breakdown of the type of claims and which form is appropriate:
CMS-1500:
This is the red-ink on white paper standard claim form used by physicians and suppliers for claim billing. Any non-institutional provider and supplier can use the CMS-1500 for billing medical claims.
- Physician services
- Physician assistants
- Nurse practitioners
- Clinical nurse specialists
- Nurse midwives
- Certified registered nurse anesthetists
- Clinical psychologists
- Clinical social workers
- Home dialysis supplies and equipment
- Ambulance services
- Clinical diagnostic laboratory services
UB-04:
This is the red-ink on white paper standard claim form used by institutional providers for claim billing. Any institutional provider can use the UB-04 for billing medical claims.
- Community Mental Health Center
- Comprehensive Outpatient Rehabilitation Facility
- Critical Access Hospital
- End-Stage Renal Disease Facility
- Federally Qualified Health Center
- Histocompatibility Laboratory
- Home Health Agency
- Hospice
- Hospital
- Indian Health Services Facility
- Organ Procurement Organization
- Outpatient Physical Therapy Services
- Occupational Therapy Services
- Speech Pathology Services
- Religious Non-Medical Health Care Institution
- Rural Health Clinic
- Skilled Nursing Facility