The Paper claim CMS-1500
Types of submitted claims
Health insurance claim form (CMS-1500)
Claim completion guidelines
Instructions for completing the health insurance claim form (CMS-1500)
100

Who mandated CMS-1500 claim forms be electronic?

ASCA

100
A _____ is a claim that was submitted within a third party payer's time limit and contains all necessary information so that it can be processed and paid promptly. 

clean claim  

100

The CMS-1500 form has the ability to report ___ diagnostic codes 

12

100

Do or don't 

use original claim forms printed in red ink; photocopies and forms generated from ink jets or laser printers cannot be scanned. 

DO

100

Who developed a general instruction guide for completing the CMS-1500 claim form?

NUCC

200

Who developed the CMS-1500 claim form?

National Uniform Claim Committee (NUCC)

200
A _____ is one that has no staples or highlighted areas and on which the bar code area has not been deformed. 

physically clean claim 

200

If there are any questions that are not answerable, you should 

leave the space blank 

200

True or false

It is okay to hand write on the CMS-1500 form. 

false

200
True or False

It is recommended that claims aren't processed using the NUCC guidelines. 

False

300

The ____ is the standard paper claim form. 

CMS-1500
300

A ____ is a claim submitted with errors, one requiring manual processing for resolving problems, or one rejected for payment. 

dirty claim 

300

NPI stands for?

National Provider Identifier 

300
What is used to scan the majority of paper claims?

Optical character recognition (OCR)

300

The carrier block can be found in the ____ corner of the CMS-1500 claim form. 

upper right

400
Who attempted to standardize the insurance claim form?

HIAA and the AMA

400

A ____ is any Medicare claim missing required information 

incomplete claim 

400

A health care organization may file taxes as a group and thus be under the same ____. 

employer identification number (EIN) or tax identification number (TIN)

400

DO or DON'T

align the printer correctly so that characters appear exactly in the proper fields. Enter all information within designated fields. 

DO

400

What is in the upper left corner of a CMS-1500 form?

Quick response (QR) code symbol and the date approved by the NUCC can be located. 
500

True or False

The paper claim form can be used under special circumstances. 

True 

500

A ____ has not been processed or cannot be processed for various reasons. 

rejected claim 

500
What should you do if the patient brings in a form from a private insurance plan that is not a CMS-1500 claim form? 

Have the patient sign the CMS-1500 claim form in Block 13 (assignment of benefits). Mail the CMS-1500 form and the patient's form together. 

500

DO or DON'T

use paper clips, cellophane tape, stickers, rubber stamps, or staples

DON'T

500

Updated versions of the NUCC instruction manual are released each ___. 

July

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