CMS 1500 BILLING INSTRUCTIONS #how #to #claim #incapacity #benefit

hcfa 1500 claim form


Provided on this page are some general billing reminders and specific instructions for billing on the CMS-1500 (12-90) claim form.

Providers should note the following:

  • Providers may submit more than one claim per envelope to reduce provider postage costs and to aid Molina Medicaid Solutions in handling mail.
  • Providers should always notify the Bureau of Health Services Financing (BHSF) when a mailing address change occurs to allow rejected claims to be returned more quickly to providers. Many claims are returned to Molina because forwarding orders at the post office have expired.
  • Claims should be filed immediately after services have been provided.
  • Medicaid is the payer of last resort.

Sample CMS 1500 claim form and instructions

NOTE: This form is available in Portable Document Format (PDF) and can be accessed using Adobe Acrobat Reader 3.0 or higher. If you do not already have Adobe Acrobat Reader 3.0 or higher, click Download Acrobat .

Professional services are billed on the CMS-1500 (formerly known as HCFA-1500) claim form. Items to be completed are either required or situational. Required information must be entered in order for the claim to process. Claims submitted with missing or invalid information in these fields will be returned unprocessed to the provider with a rejection letter listing the reason(s) the claims are being returned. These claims cannot be processed until corrected and resubmitted by the provider. Situational information may be required (but only in certain circumstances as detailed in the instructions below). Claims should be submitted to:

Molina Medicaid Solutions
P.O. Box 91020
Baton Rouge, LA 70821

*1.REQUIRED Enter an �X� in the box marked Medicaid (Medicaid )

*1A.REQUIRED Enter the recipient�s 13 digit Medicaid ID number exactly as it appears in the recipient�s current Medicaid information using the plastic Medicaid swipe card (MEVS), e-MEVS, or through REVS

NOTE : The recipients� 13-digit Medicaid ID number must be used to bill claims. The CCN number from the plastic ID card is NOT acceptable.

Note:If the 13-digit Medicaid ID number does not match the recipient�s name in block 2, the claim will be denied. If this item is blank, the claim will be returned.

*2.REQUIRED Print the name of the recipient: last name, first name, middle initial. Spell the name exactly as verified through MEVS, e-MEVS or REVS

3.SITUATIONAL Enter the recipient�s date of birth as reflected in the current Medicaid information available through MEVS, e-MEVS or REVS, using six (6) digits (MM DD YY). If there is only one digit in this field, precede that digit with a zero. Enter an �X� in the appropriate box to show the sex of the recipient.

4.SITUATIONAL Complete correctly if appropriate or leave blank

5.SITUATIONAL Print the recipient�s permanent address

6.SITUATIONAL Complete if appropriate or leave blank

7.SITUATIONAL Complete if appropriate or leave blank

9.SITUATIONAL Complete if appropriate or leave blank

9A.SITUATIONAL If recipient has no other coverage, leave blank. If there is other coverage, put the state assigned 6-digit TPL carrier code in this block – make sure the EOB is attached to the claim.

9B.SITUATIONAL Complete if appropriate or leave blank

9C.SITUATIONAL Complete if appropriate or leave blank

9D. SITUATIONAL Complete if appropriate or leave blank

11.SITUATIONAL Complete if appropriate or leave blank

11A.SITUATIONAL Complete if appropriate or leave blank

11B.SITUATIONAL Complete if appropriate or leave blank

11C.SITUATIONAL Complete if appropriate or leave blank

12.SITUATIONAL Complete if appropriate or leave blank

13.SITUATIONAL Obtain signature if appropriate or leave blank

14.SITUATIONAL Leave blank

17.SITUATIONAL If services are performed by a CRNA, enter the name of the directing physician.

If services are performed by an independent laboratory, enter the name of the referring physician.

If services are performed by a nurse practitioner or clinical nurse specialist, enter the name of the directing physician.

If the recipient is a lock-in recipient and has been referred to the billing provider for services, enter the lock-in physician�s name.

17A.SITUATIONAL If the recipient is linked to a PCP, the Primary Care Physician referral authorization number must be entered here.

18.SITUATIONAL Leave blank

*21.REQUIRED Enter the ICD-9 numeric diagnosis code and, if desired, narrative description. Use of ICD-9-CM coding is mandatory. Standard abbreviations of narrative descriptions are accepted.

22.SITUATIONAL Leave blank

23.SITUATIONAL Complete if required or leave blank

*24A.REQUIRED Enter the date of service for each procedure. Either six-digit (MMDDYY) or eight-digit (MMDDCCYY) format is acceptable.

*24B.REQUIRED Enter the appropriate code from the approved Medicaid place of service code list.

*24D.REQUIRED Enter the procedure code(s) for services rendered.

*24E.REQUIRED Reference the diagnosis entered in item 21 and indicate the most appropriate diagnosis for each procedure by entering either a �1�, �2�, etc. More than one diagnosis may be related to a procedure. Do not enter ICD-9-CM diagnosis code

*24F.REQUIRED Enter usual and customary charges for the service rendered

*24G.REQUIRED Enter the number of units billed for the procedure code entered on the same line in 24D

24H.SITUATIONAL Leave blank or enter a �Y� if services were performed as a result of an EPSDT referral

24K.SITUATIONAL Enter the attending provider number if group number is indicated in block 33

25.SITUATIONAL Leave blank

26.SITUATIONAL Enter the provider specific information assigned to identify the patient. This number will appear on the Remittance Advice (RA). It may consist of letters and/or numbers and may be a maximum of 16 characters.

27.SITUATIONAL Leave blank. Medicaid does not make payments to the recipient. Claim filing acknowledges acceptance of Medicaid assignment.

*28.REQUIRED Total of all charges listed on the claim

29.SITUATIONAL If block 9A is completed, indicate the amount paid; if no TPL, leave blank

30.SITUATIONAL If payment has been made by a third party insurer, enter the amount due after third party payment has been subtracted from the billed charges

*31.REQUIRED The claim form MUST be signed. The practitioner is not required to sign the claim form. However, the practitioner�s authorized representative must sign the form. Signature stamps or computer-generated signatures are acceptable, but must be initialed by the practitioner or authorized representative. If this item is left blank, or if the stamped or computer-generated signature does not have original initials, the claim will be returned unprocessed.

Date Enter the date of the signature

32.SITUATIONAL Complete as appropriate or leave blank

*33.REQUIRED Enter the provider name, address including zip code and seven (7) digit Medicaid provider identification number. The Medicaid billing provider number must be entered in the space next to �Group (Grp) .�

Note. If no Medicaid provider number is entered, the claim will be returned to the provider for correction and re-submission.

Marked (*) items must be completed or form will be returned.


Holiday Claims #workers #compensation #claim

holiday claims

Holiday Illness Claims Solicitors

Simpson Millar LLP Holiday Law Experts

Simpson Millar’s Holiday Illness Claims Solicitors provide a specialist service for victims of food poisoning whose holidays were spoilt by poor hygiene standards at hotels abroad, on-board cruise ships, and whilst travelling on aircraft.

With unrivalled experience and an outstanding record. our team comprises of dedicated and qualified holiday lawyers who have worked within the Legal Departments of the UK’s major tour operators including Thomson, First Choice, Airtours and Thomas Cook Tour Operations Ltd.

We are confident in our ability to win compensation and so we accept most food poisoning and illness claims on a no win no fee basis .

If you have been ill abroad and have been diagnosed with campylobacter, E. coli, cryptosporidium, salmonella or any other type of water or food poisoning, the 1992 Package Travel Regulations and other legislation help unhappy holidaymakers claim compensation!

Simpson Millar is a leading national law firm, offering a personal and professional service for those who have suffered sickness abroad through no fault of their own.

In 2013 we helped hundreds of holidaymakers who returned to the UK ill claim compensation directly from their tour operator. Illness can be avoided if hotels and their operators adhere to basic food safety standards such as those set out by the World Health Organisation.

If you experienced food poisoning whilst on a package holiday abroad, you are legally entitled to claim compensation from your tour operator.

Worried about how much it might cost to make a holiday illness claim?

“Most illness on holiday claims we take on are accepted on a no win no fee basis.” – Nick Harris. Head of Holiday Claims at Simpson Millar Solicitors LLP .

As a national law firm with an immense reputation for maximising compensation you can be assured that we simply don’t turn over case to maintain cash flow.”Simon Lomax. Holiday Illness Claims Manager .

“Our success in holiday claims is evidenced by the fact that we can offer insurance at only £150 plus 9.5% tax payable at the end of the claim. Higher insurance means a higher case abandonment rate! Make sure it not your case – contact Simpson Millar.”James Blower. Holiday Illness Solicitor.

Have you been ill on holiday? Get in touch for free advice and to find out just how easy it is to make a holiday illness compensation claim.


Holiday Accident Claims Specialists #claiming #emergency #tax #back

holiday claims

Most people come back from holiday having had a good time but unfortunately, some will have had a less than enjoyable experience after having their holiday ruined by a holiday accident or illness on holiday.

If you had your holiday spoilt because you, or a family member, became ill or suffered an accident caused by the negligence or recklessness of a third party, it is possible that you may be able to make a holiday compensation claim.

Macks Solicitors are a specialist legal firm that has successfully recovered hundreds of thousands of pounds in holiday compensation for clients who have been involved in a holiday accident or suffered an illness on holiday.

If you suffered a holiday accident or illness on holiday in this country your holiday compensation claim can be handled in much the same way as any other personal injury claim and Macks Solicitors will be happy to advise you in this regard.

Holidays abroad that have been purchased as part of a package are covered by the Package Travel Regulations that were introduced in 1992. These regulations allow a holiday compensation claim to be made in the UK for a holiday accident or illness on holiday abroad.

On a package holiday, the tour operator organises, and is therefore responsible for, all the elements that make up the “package”. This includes transport to and from the holiday destination, the accommodation and any catering that is included, and may also include “extras”, such as excursions. If you are injured in a holiday accident or suffer an illness on holiday you may be able to make a claim against the tour operator or travel company that made the booking.

The types of incident for which compensation may be claimed are:

Holiday Accidents

  • Accidents caused by collapsing furniture, faulty fittings and defective flooring.
  • Accidents in and around the hotel restaurant or bar
  • Accidents in and around swimming pools and the hotel grounds
  • Accidents on Cruise ships
  • Road traffic accidents on the transfer journeys or on trips organised by the tour company

Illness on holiday

  • Food poisoning as a result of poor hygiene standards
  • Carbon monoxide poisoning
  • Other illness e.g. Legionnaires disease, Norovirus

Macks Solicitors is a specialist personal injury practice. Our skilled solicitors are happy to provide legal advice to anyone who has been injured in a holiday accident or has suffered illness on holiday.

As an independent law firm, Macks Solicitors does not take referrals from claims management companies, tour operators or insurers. Macks clients are therefore confident that the solicitor who is handling their holiday compensation claim is acting in their best interests.


Claim Synonyms, Claim Antonyms #claim #for #compensation

what is a claim


Word Origin & History

claim c.1300, from O.Fr. clamer “to call, claim,” from L. clamare “to cry out, shout,” from PIE *kele- “to shout,” onomatopoeic (cf. Skt. usakala “cock,” lit. “dawn-calling;” L. calare “to announce solemnly, call out;” M.Ir. cailech “cock;” Gk. kaleo “to call,” kelados “noise,” kledon “report, fame;” O.H.G. halan “to call;” O.E. hlowan “to low, make a noise like a cow;” Lith. kalba “language”). The noun meaning “piece of land allotted and taken” (chiefly U.S. and Australia, in reference to mining) is from 1851. Claim properly should not stray too far from its true meaning of “to demand recognition. of a right.” Insurance sense is from 1878.

Example Sentences for claim

I come, Lucullus, to ask your assistance, to claim your sympathy and help.

The good man may be weak, be indolent; Nor is his claim to plenty, but content.

These men had, undoubtedly, the right to claim such a protection.

There are those that claim that they achieve for human kind and not for their own race alone.

His protest is against forms of death; his claim is for life.

It will disabuse his mind of the notion that he has any claim on me.

His advice was that if it happened I must claim to be a German officer.

“He who has come through that wall of flaring fire may claim me,” Brynhild said.

The residue of the claim is reserved for future consideration.

This was not done by the English, who had made the first claim to the land, but by the Dutch.


Vipul Medcorp Tpa Claim Form Download – Claim Drive #pet #secure #claim #form

vipul medcorp claim form

Vipul Medcorp Tpa Claim Form Download

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Vipul Medcorp Tpa Pvt Ltd, Sayaji Ganj, Vadodara – Third Party Administrator #claiming #for #whiplash

vipul medcorp claim form

Vipul Medcorp Tpa Pvt Ltd

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    Vipul Medcorp Cashless Claim Form – Modern Claim #workers #comp #claims

    vipul medcorp claim form

    Vipul Medcorp Cashless Claim Form

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    What is Product Liability? #claim #your

    product liability claims

    What is Product Liability?

    Defective or dangerous products are the cause of thousands of injuries every year in the U.S. Product liability law , the legal rules concerning who is responsible for defective or dangerous products, is different from ordinary injury law, and this set of rules sometimes makes it easier for an injured person to recover damages.

    Product liability refers to a manufacturer or seller being held liable for placing a defective product into the hands of a consumer. Responsibility for a product defect that causes injury lies with all sellers of the product who are in the distribution chain. In general terms, the law requires that a product meet the ordinary expectations of the consumer. When a product has an unexpected defect or danger, the product cannot be said to meet the ordinary expectations of the consumer.

    There is no federal product liability law. Typically, product liability claims are based on state laws, and brought under the theories of negligence. strict liability. or breach of warranty. In addition, a set of commercial statutes in each state, modeled on the Uniform Commercial Code, will contain warranty rules affecting product liability.

    For product liability to arise, at some point the product must have been sold in the marketplace. Historically, a contractual relationship, known as privity of contract , had to exist between the person injured by a product and the supplier of the product in order for the injured person to recover. In most states today, however, that requirement no longer exists, and the injured person does not have to be the purchaser of the product in order to recover. Any person who foreseeably could have been injured by a defective product can recover for his or her injuries, as long as the product was sold to someone.

    Liability for a product defect could rest with any party in the product’s chain of distribution, such as:

    • The product manufacturer;
    • A manufacturer of component parts;
    • A party that assembles or installs the product;
    • The wholesaler; and
    • The retail store that sold the product to the consumer.

    For strict liability to apply, the sale of a product must be made in the regular course of the supplier’s business. Thus, someone who sells a product at a garage sale would probably not be liable in a product liability action.

    Types of Product Defects

    Under any theory of liability, a plaintiff in a product liability case must prove that the product that caused injury was defective, and that the defect made the product unreasonably dangerous. There are three types of defects that might cause injury and give rise to manufacturer or supplier liability:

    1. Design Defects – Present in a product from the beginning, even before it is manufactured, in that something in the design of the product is inherently unsafe.
    2. Manufacturing Defects – Those that occur in the course of a product’s manufacture or assembly.
    3. Marketing Defects – Flaws in the way a product is marketed, such as improper labeling, insufficient instructions, or inadequate safety warnings.

    The doctrine known as res ipsa loquitur shifts the burden of proof in some product liability cases to the defendant(s). Translated, this Latin term means the thing speaks for itself, and indicates that the defect at issue would not exist unless someone was negligent. If the doctrine is successfully invoked, the plaintiff is no longer required to prove how the defendant was negligent; rather, the defendant is required to prove that it was not negligent.

    The second rule that helps plaintiffs in product liability cases is that of strict liability. If strict liability applies, the plaintiff does not need to prove that a manufacturer was negligent, but only that the product was defective. By eliminating the issue of manufacturer fault, the concept of no-fault, or strict liability allows plaintiffs to recover where they otherwise might not.

    Unavoidably Unsafe Products

    By their nature, some products simply cannot be made safer without losing their usefulness. For example, an electric knife that is too dull to injure anyone would also be useless for its intended purpose. It is generally believed that, as to such products, users and consumers are the best equipped to minimize risk. Thus, while a product might not be deemed unreasonably dangerous, manufacturers and suppliers of unavoidably unsafe products must give proper warnings of the dangers and risks of their products so that consumers can make informed decisions regarding

    Common Defenses to Product Liability Claims

    A defense often raised in product liability cases is that the plaintiff has not sufficiently identified the supplier of the product that allegedly caused the injury. A plaintiff must be able to connect the product with the party(ies) responsible for manufacturing or supplying it. There is an exception to this rule, known as the market share liability exception, which applies in cases involving defective medications. Where a plaintiff cannot identify which of the pharmaceutical companies that supply a particular drug supplied the drug he/she took, each manufacturer will be held liable according to its percentage of sales in the area where the injury occurred.

    Another defense a manufacturer might raise is that the plaintiff substantially altered the product after it left the manufacturer’s control, and this alteration caused the plaintiff’s injury. A related defense is that the plaintiff misused the product in an unforeseeable way, and that his/her misuse of the product cause the injuries alleged.

    Get Free Legal Help for a Defective Product Injury Today

    Product liability actions are quite complex, and establishing legal fault often requires the assistance and testimony of experts. Additionally, every state has its own laws and specific statutes that will affect a product liability action. If you or a loved one has suffered an injury caused by a potentially defective product, contact an experienced accident and injury attorney to have your claim evaluated free of charge .


    Online claims #no #claims #discount #rules

    online claims

    Faster, Easier Claims

    Online claim process is packed with benefits

    Easy filing
    Filing claims online now requires less time and fewer steps. You can start a claim without logging in: just use the tracking number.

    Automated information
    For packages you ship, we ll pre-populate your claim with information from your account after you ve logged in.

    Drag and drop documents now or later
    You can add documentation when you file a claim, or even add it later. Use our convenient drag and drop feature to move supporting documentation from your desktop to your claim.

    Informative updates
    Stay informed automatically. Request to receive periodic claim status updates by email when you file a claim.

    Convenient claim access
    Check your claim s status online on your schedule. You can also cancel your claim or view details.

    Flexible reporting
    See or share claim information easily. View and download your claim reports in various formats up to 12 months after you file a claim.

    Your claims, your way
    Set up account preferences for notifications, proactive emails, claim payments, and administrative functions. You also can determine who can access your account s claim filing, status, and reports.

    Let’s get started

    Step 1: Start a claim online
    Start your claim for U.S. domestic shipments and international shipments that originated from the U.S.:

    • Enter tracking number
    • Specify your claim type: damaged shipment, lost shipment, or missing contents
    • Complete the online claim form
    • Add your supporting documentation now or later

    To file claims for international shipments originating from outside the U.S. (except Canada), contact FedEx International Customer Service at 1.800.GoFedEx 1.800.463.3339 for assistance.

    Step 2: Add supporting documents (not required for claim values of less than $100.)
    Drag and drop supporting documents from your desktop to your online claim. Documentation may include:

    • Scan of FedEx US Airbill, FedEx Ship Manager printout, and/or FedEx Ground Pickup Record.
    • Photos of package and damaged contents (if appropriate). Keep all original packaging, including cartons and contents, until the claim resolution process is finished.
    • Serial number(s) of damaged or lost merchandise.
    • Proof-of-value documentation: copy of original invoice from vendor/supplier, copy of retail invoice/receipt, final confirmation screen (if it s an online order) with proof of payment, itemized repair invoice or statement of non-repair, appraisal(s), expense statement, or any other applicable documentation.

    You may also mail or fax documentation to FedEx Cargo Claims:

    FedEx Cargo Claims Dept.
    P.O. Box 256
    Pittsburgh, PA 15230
    Fax 1.877.229.4766 (toll-free)

    If you fax your claim, you will receive a confirmation by return fax.

    Step 3: Submit your claim
    Review the information you have entered, submit the claim form, and print your case number page for your records.

    Step 4: Schedule an inspection
    If an inspection is necessary for your claim, FedEx will notify you. You may be asked to call FedEx Customer Service at 1.800.GoFedEx 1.800.463.3339 to schedule an inspection. It may be necessary to make the original packaging, including cartons and contents, available to FedEx for inspection and to keep these materials until your claim is resolved.

    Step 5: Track the status of your claim
    A FedEx claims agent will review and process your claim. If you claim a lost shipment, FedEx will perform a trace. When your claim is resolved, FedEx will notify you. You can check the status of your claim online at any time or request to receive updates by email.

    Please note:
    Most claims are resolved five to seven business days after submission. It may take longer if additional research is needed.


    HCFA-1500 Fill and Print NPI – Free download and software reviews – CNET #small #claims

    hcfa 1500 claim form

    HCFA-1500 Fill and Print NPI

    2010-05-06 08:26:11 | By BlankensteinMD

    | Version: HCFA-1500/CMS 1500 Fill Print NPI 1.4

    -Simple to use interface
    -Can open saved claims and easily make changes (for repetitive patients)
    -Speeds up the time it takes to send and receive $
    -Had an issue, called technical support, and they were eager to assist

    -I did not find any cons with the software

    As a MD, I would recommend this product to anyone who is not interested in a full-blown practice management software, which can cost upwards of $5000. This software is easy to use and affordable. I have recommend this product to several other practices.


    2010-02-08 14:20:53 | By nosnittap

    | Version: HCFA-1500/CMS 1500 Fill Print NPI 1.4

    Wouldn’t line up on forms. Sent two requests to both sales and support. heard nothing back. Called them–guy had no answers on anything–told me to check website which he didn’t have access to! Asked for refund. Heard nothing. Rip-off.

    Too many other options to risk this product

    Reply by UB04-Software-Support on May 6, 2010

    nosnittap, we are sorry to hear about your experience and take pride in our customer service and work ethic. Any time we receive a request, we contact the customer back. We would never just tell our customer to ‘check the website,’ and we most certainly would have access to our own website. We have a 30 day money-back guarantee on all of our purchases and would be happy to discuss a refund even at this point. Feel free to contact us toll free at 866-829-2763 x 2 (Support). Thank you, The UB-04 Software Support Staff

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