1. Patient health record.
It is essential to submit a comprehensive patient health record with the CMS-1500 claim form. This should include all medical records related to the patient's care, including diagnosis, treatment plan, and test results. All relevant information must be up-to-date and accurate. The patient health record must also include any relevant information regarding the patient's prior insurance coverage and any existing health conditions.
2. Patient insurance card information.
The provider must submit a copy of the patient's insurance card with the CMS-1500 form, including the name and address of the patient as well as their policy number. It is also important to note that Medicare requires an original copy of this document for reimbursement purposes.
3. Encounter form.
A complete encounter form should be completed at each visit and submitted with the CMS-1500 claim form. This should include all services performed, diagnoses, treatments rendered, medications prescribed or administered, date of service, place of service, diagnosis code(s) used and any other relevant information needed for proper payment of the claim.
4. Insurance claim processing guidelines.
It is important to review the insurance company's processing guidelines before submitting a CMS-1500 form. These guidelines will provide specific instructions on what information must be included with the claim and how the form should be completed. This will ensure that the claim is processed accurately and in a timely manner.
5. Patient registration form.
A patient registration form should also be submitted with the CMS-1500 form. This document gives permission for healthcare providers to access and use the patient’s health records, as well as provide basic demographic information such as name, address, social security number, date of birth etc.
6. Precertification information.
Any precertification information should also be included with the CMS-1500 form. This may include any prior authorization numbers, referral information and diagnostic tests that need to be performed before a claim can be approved. The precertification process must be completed in order for the provider to receive reimbursement from insurance companies.