March 24, 2023

Lemon Law

Learn ethics in law

HCFA 1500 or CMS 1500: Which Is Better?

As the insurance industry clients have grown into billions of people, healthcare services are also improving what they can offer their clients. Even the claim forms have evolved themselves. Traditional paper claim forms have become electronic claim forms that are readily downloadable from the World Wide Web. This change was made to ensure that claims are accurately, and efficiently files, so as to speed up the reimbursement of claims.

The previous form, HCFA 1500 has already been rendered as obsolete ever since the new form has emerged. The experts in the industry are saying that the newer form is a better version, as the loopholes from the previous form were already addressed. But let us compare the two forms.

HCFA 1500

This form was the pre-HIPAA version of the form, and which all the medical providers used to send claims to insurance companies. The form was a complicated one in which the doctor’s office should list down all the necessary patient demographics and insurance information. No NPI numbers were not existing yet, it was not included in the claim form.

CMS 1500

In the new form released, loopholes were accounted for, since the goal of revising the forms were to ensure accuracy and efficiency in the information stored in the records. There were major changes that were implemented in the CMS 1500. Such included the change in language; in the format of the boxes, including the size; inclusion of the NPI number in a separate box so as to avoid confusion; removal of barcode from the header, to be able to give more space for noting the address of the payer; supplements can already be attached at the top center area of the form; the website address wherein form fillers can obtain the instruction manual is already added in the new CMS form.

Even if the changes be considered just minor in nature, but these could already be of help especially in tracing the filed and reimbursed claims in the future if needed. For those who have not yet been oriented with the new CMS 1500 form, there is an available tutorial online to let you be familiarized with the different parts as indicated.

Downloadable forms and demos are also available online. If you want other sources, you may just key in cms 1500 claim form in your search engine and it will direct you to choices you might want.