The Universal Health Claim Form (HCFA-1500), is accepted in most states and is submitted on behalf of a patient who is covered by medical insurance. In order for a claim to be processed by an insurance company, there are key pieces of information which must be included to prevent a claim from being delayed or denied.
Instructions
Guidelines for Submission
1. Verify the patient's insurance eligibility by obtaining her insurance card and calling the customer service number located on the back of the card. The majority of insurance eligibility verification is done via an automated phone system.
2. Use the patient registration form, to complete items one to 13. If a signature was obtained on an assignment of benefits form during registration, "SOF" or signature on file can be inserted in block 12 and 13. Otherwise, the patient is required to sign these two fields.
3. Locate the diagnosis code on the encounter form and enter the code in block 21 on the claim form. If more than one diagnosis is provided on the superbill, be sure to enter all of them in the spaces provided.
4. Enter the dates of service in section 24a, the place of service (POS) code, type of service (TOS) code and procedure codes in boxes 24 b, c and 24d. Section 24f is used to input the cost for each procedure.
5. Provide the physician's identification number in block 25, checking the appropriate box to indicate whether it is the provider's Social Security number or employer identification number. Insurance companies require the identification number on a claim form to bill for the services performed.
6. Physician's signature
Ensure the physician signs box 31. If a stamped signature is used, the stamp must be completely inside the box to be accepted. Include the physician's physical address in box 33 and the POS physical address in box 32 if other than the physicians home office.
Tags: identification number, claim form, insurance eligibility, physical address, service code