CMS - 1500 Form

Question 1

What is a CMS 1500 form ?

Answer 1

form for claims submitted by provider or supplier. Med Assistant must include all information needed to complete form, including pt and guarantor demographic and insurance info, diagnostic tests, treatment, or procedure information and billing information

Question 2

How many blocks/ items does the CMS1500 form have ?

How many sections is it divided into ?

Answer 2

It has 33 blocks/ items which are divided into 3 sections

Question 3

Section 1 : Carrier Block

Answer 3

contains address of insurance carrier and is at the top of the form

Question 4

Section 2 : Patient / insured Section

Answer 4

contains Info of pt or insured ( if other than patient
included boxes 1 through 13

Question 5

Section 3 : Physician /Supplier section

Answer 5

contains info about the physician or supplier : includes boxes 14-33