CMS Claim Forms

CMS 1500 Forms (formerly HCFA 1500 forms) and UB 04 Forms (formerly UB 92 forms)

CMS 1500 forms are the standardized medical billing forms for professional (non-institutional) medical billing of health insurance claims in the United States. The current CMS 1500 form version is 08/05, revised by the National Uniform Claim Committee (NUCC) in June 2007 to accommodate updates due to the HIPAA law. The Centers for Medicare and Medicaid Services (CMS) also called the CMS 1500 forms, the approved OMB-0938-0999 form.

What is the importance of accept assignment?

Field 27 

Item 27 - Check the appropriate block to indicate whether the provider of service or supplier accepts assignment of Medicare benefits. If Medigap is indicated in item 9 and Medigap payment authorization is given in item 13, the provider of service or supplier shall also be a Medicare participating provider of service or supplier and accept assignment of Medicare benefits for all covered charges for all patients.

The following providers of service/suppliers and claims can only be paid on an assignment basis:
• Clinical diagnostic laboratory services;
• Physician services to individuals dually entitled to Medicare and Medicaid;
• Participating physician/supplier services;
• Services of physician assistants, nurse practitioners, clinical nurse specialists, nurse midwives, certified registered nurse anesthetists, clinical psychologists, and clinical social workers;
• Ambulatory surgical center services for covered ASC procedures;