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Submitting Medical Insurance Claims - Which Form Do I Use?

When it comes to submitting medical insurance claims to the insurance companies, it is important to file the claims on the appropriate forms. The most common medical insurance form is the HCFA 1500.

The HCFA 1500 form is a 8 ½"by 11" white paper printed with red ink. It contains many fields that must be completed. In an effort to standardize the medical industry, HIPAA (Health Insurance Portability and Accountability Act of 1996) mandated that all medical service providers use the HCFA 1500 form when submitting insurance claims.

It is crucial that the fields on the HCFA form are filled out accurately and completely. If any information is missing or incorrect it can cause the entire claim to be denied. In some cases they will return the incomplete or inaccurate claim with an explanation as to why it is not being paid. Other times, you just don't hear anything. Did they end up with your socks that never returned from the dryer?

There are some instances that a HCFA wouldn't be used. If the claim is for an on the job injury, or a workers' compensation claim, then a workers' compensation form would be used. These forms vary from state to state, but can usually be found on the state's workers' compensation website.

In many states forms can be downloaded and printed or purchased in quantity by private suppliers. Some medical billing software comes with the capability of printing the workers' compensation forms. The workers' compensation forms are white with black print and have fields similar to the HCFA 1500 form. As with the HCFA 1500, it is important that these fields are filled out accurately and completely.

Facilities such as hospitals, outpatient clinics, and ambulatory surgery centers use a UB92 form. It is the facility version of the HCFA 1500. UB92 forms are also white with red ink, but the fields are different.

When claims are submitted electronically, no forms are needed as the claims are not ever printed to paper. The claims are actually put into the correct format and sent on to the insurance companies in a file. The claims can either be sent via the internet, or thru the phone lines.

HCFA and UB92 forms can be purchased from a variety of suppliers and they vary greatly in price. The higher the quantity purchased, the lower the price per form. Shop around to find the best buy.

1 comment:

  1. As much as three quarters of hospital staff are usually burdened with some sort of billing-related work in a traditional billing system. Opting for electronic medical billing solutions (ones that come with free EMR plans) that fit easily into the healthcare business' workflow are key to freeing up staff resources.
    Medical Billing Services

    ReplyDelete

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