Everyone makes mistakes. Unfortunately, sometimes small mistakes will cost you big time. Such is the case with claim form errors. The CMS form 1500 is your primary means of getting reimbursement from Medicaid, Medicare, and Tricare.

Even a minor claim form error can delay processing and payment or worse—lead to denial. On the flip side, you can avoid claim form errors when you fill out CMS form 1500 correctly and completely the first time.

Considering how lengthy and somewhat confusing the documentation is, though, that’s not always an easy task. We’ve compiled some best practices to help you navigate CMS form 1500 so you can receive the reimbursements you’re due!

Claim Form Errors: Follow These Busting Instructions

While the item numbers on CMS form 1500 are labeled, they are just labels, not explanations. Before you attempt to fill out CMS form 1500, reference a comprehensive instruction manual for clarification. The National Uniform Claim Committee (NUCC) created a reference manual with a detailed item breakdown on how to complete this form. And, because human error is the primary reason for claim form errors, heed these tips when you complete your forms:

• Take one field at a time. Don’t rush through the process of filling out the claim form, and if you have any doubts on how to correctly fill out a field, seek guidance.
• Double check your digits. From insurance IDs to policy numbers to authorization numbers and account numbers, you’ll be inputting plenty of digits on your claim forms. Don’t wait until you are done — double check each field as you input the information to verify accuracy. Transposing digits is an easy mistake to make but a slow process to rectify if you submit the form with the wrong information.
• Input information completely and correctly. Pay close attention that you enter the member and insurance company names exactly as they appear on the member’s ID card. Also, enter the patient address and phone number information in full.

Watch for these 3 Claim Form Errors Trouble Spots

There are several fields that carry a high incidence of claim form error. When you fill out your claim form, be sure to pay attention to these common problematic items:

• Enter the correct qualifier. New on the updated CMS 1500 form is the request for a provider qualifier. For item 17 you must now enter the correct 2-character qualifier for the provider you are reporting, indicating whether they are a referring, ordering, or supervising provider. The correct qualifiers are as follows:
  • DN – Referring Provider
  • DK – Ordering Provider
  • DQ – Supervising Provider
• Enter the correct diagnosis pointer. For Item 24E you must enter the correct diagnosis code reference letter (pointer) that you indicated in Item 21 that relates to the reason the service was performed. Tip: You must use ICD-10 codes!
• Include provider signature and contact information. While not an item with a high incidence of error, these fields are often left blank, causing delays in payments. For Item 31 you must include a physician’s signature. This can be an electronic signature or a stamp, but it must be complete. For Item 33 you must include the name, complete address, and phone number for the provider or supplier requesting payment.

Complete a Legible Claim Form Even if you meet the exceptions to submit a paper claim form, you should still fill it out electronically then print the form to mail it. Many claim form errors are due to illegible information. Here are some best practices you should follow to avoid processing delays:

• Use one font, such as Arial, between 10-12 points.
• Don’t use an italic, bold, or script font.
• Use all caps.
• Make the text black. Don’t ever color the text red.
• If you print the form, make sure your printer isn’t leaving residual toner or ink markings on the form.
• Make sure your text is properly aligned in the fields.
• Don’t print with a dot matrix printer because OCR scanners can’t read the broken text.

Tip: If you must handwrite the form, take your time, use black ink, and make sure your handwriting is unquestionably legible.

Consider Professional Training on Claim Form Errors

You’ve probably attended a training session to learn how to use computer software or how to deal with critical coworkers. Considering that the claim form is critical to your practice’s cash flow, expert training with a line by line breakdown of how to complete CMS 1500 is a wise investment. A training session offers many benefits including:

• An opportunity to ask personalized questions and receive immediate feedback
• Case studies of mistakes that have cost other practices their reimbursements
• Tricks of the trade that will help you get reimbursements quicker

To help you master the complexities of the CMS 1500 Claim Form, expert Brenda Edwards, CPC, CDEO, CPB, CPMA, CPC-I, CEMC, CRC, CMRS, CMCS has gone through the form line by line, and has broken down each important element for you. In her 60-minute online presentation, Brenda gives you the tactics you need to file this essential form correctly the first time so you can get paid more quickly, accurately and efficiently.

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