Question
Hello, Your articles are great and very helpful. You are now in my favorites!
My question:
• Can anyone complete a Claim Form 1500? Or just a biller/provider?
• Can a patient complete on behalf of a Physician?
• Can anyone (other than biller/physician) re-enter info from a bill or receipt onto a 1500 form for "insurance purposes" ?
Thanks,
Mars
Answer
Hi Mars,
Glad you are enjoying our website and articles. We try to add new info every week.
The CMS 1500 forms are meant for providers to complete on behalf of their patients. If a patient needs to submit a bill directly, usually they have a claim form provided by their insurance carrier that they attach a statement from their provider’s office (which can be a CMS form, or another form of statement). It would be difficult for a patient to complete one on behalf of the physician since they would need to data from the physician (tax id#, NPI #, billing info, cpt codes, icd9 dx codes, etc.) and they would have to know where to place the info on the CMS form.
I don’t think that insurance carriers allow ‘anyone’ to re-enter information since they have to worry about fraud. Only a dr can diagnose a patient and state what services were performed. The patient shouldn’t be able to change information given to an insurance carrier by a dr.
Michele