An overview of the Guideline and Purpose of CMS-1500 and UB-04 Claim Forms

An overview of the Guideline and Purpose of CMS-1500 and UB-04 Claim Forms

Anoverview of the Guideline and Purpose of CMS-1500 and UB-04 ClaimForms




Anoverview of the Guideline and Purpose of CMS-1500 and UB-04 ClaimForms

  1. Basic Guidelines used when submitting a CMS-1500 claim form and UB-04 form

Variousbasic guidelines are provided when filling in CMS-1500 and UB-04claim forms. Firstly, it is important to know that electronic claim`sfiling procedure is different compared to the manual process. So thefirst step is to enter the insured’s identity number. Theidentification number is supposed to be entered as it appears on theblue shield ID card (Centers,2013).

Thesecond step is to fill in blocks 9-9d where you provide theinformation such as amount allowed, the amount payable, and theamount that is applied to as primary insurance information. Thirdly,the person making the claim should give patient`s condition in block10 a-10c. Other crucial information such as date of illness,pregnancy or injury is provided in block 14 of CMS-1500 and UB-04claim forms. The date is when an injury, pregnancy, or illnessoccurred is a must in the claim record, and it cannot be omitted.This is followed by giving the diagnosed signs and symptoms. Lastly,the form provides information about the referring or orderingphysician especially his or her ID number.

  1. Purpose of CMS-1500 and UB-04 Claim forms

BothCMS-1500 and UB-04 forms are claimed forms that are used by thehealthcare providers to bill the Medicare and other services coveredby health insurance. In this case, most of the healthcare providersaccept the Medicaid cover when giving health services (Centers,2013).The CMS-1500 for has all the basic information that is needed whensubmitting a claim that is accurate. For example, there is a fieldwhere the person making a claim fills patient’s demographic andinsurance information. Additionally, the form contains boxes where aperson can provide the dates and medical codes. Moreover, the form isdesigned such as some boxes can exclusively cater for the Medicaid orMedicare. However, it is paramount to note that various insurancepayers give different instruction when filling in the forms and theitem numbers. On the other hand, the medical biller and code issupposed to be the same depending with the payers’ requirements itgood to note this before you fill in the form. The main purpose ofCMS-1500 claim forms is to gather information required when billingMedicare information for part B services offered by healthcareproviders.

Onthe other hand, UB-08, which was formerly referred to as UB-82 formas an electronic format that represent CMS-1500 claim forms,. Themain purpose of UB-04 claim form is to ensure that the writtenpolicies are documented well and in a format that is correct(Ambrose,2011).For this reason, all the professional providers in Medicare orMedicaid are supposed to submit their claims through the CMS-1500form while the institutional providers are supposed to use UB-04 tosubmit their claims. Since UB-04 is used for electronic claims then,it is the responsibility of the workers in the health facility toexamine the information provided and determine whether there is anyexception that apply to the operations and grant usefulness of themanual claim. According to Wager,Lee, &amp Glaser (2009),all the number of exception are affirmed by the ASCA.


Ambrose,S. (2011). U.S.Patent No. 7,970,632.Washington, DC: U.S. Patent and Trademark Office.

Centers,I. F. A. S. (2013). Validation of a Medicare Claims-based Algorithmfor Identifying Freestanding Ambulatory Surgery Centers.

Wager,K. A., Lee, F. W., &amp Glaser, J. P. (2009). Healthcare information systems: a practical approach for health caremanagement.John Wiley &amp Sons.