- 1). Ask your patient for her current health insurance identification cards. Copy this information as you will need to enter their coverage information, ID number, name, address, city, state and ZIP code on the CMS 1500 claim form. You also will need to check the appropriate boxes if the care provided is in regards to the patient's employment or the result of an accident.
- 2). Input information about the patient's primary and secondary insurances. Many Medicare patients have a supplemental Medicare health insurance policy or coverage under a spouse's plan that serves as a secondary insurance
- 3). Enter "Signature on File" on Line 12 of the CMS 1500 form. This asks for your patient's signature, but it is very unlikely you would actually have a patient sign each claim form, especially if you submit forms electronically.
- 4). Enter the diagnosis code on Line 21. This code is a standardized industry code that is necessary for claims payment and must relate to the information in Section 24. If you obtained precertification of services, enter this information on Line 23.
- 5). Fill in the details for Section 24, including dates of service, place of service, industry-standard procedure codes, charges, applicable number of days or units and provider ID number.
- 6). Complete the remaining sections with the rendering provider's tax ID number, charges listed on Line 24, amounts already paid from insurers, balance due, and provider's name, address and phone number.
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