Get Cms 1500 Claim Form Requirements - Regence Blue Cross Blue ...

Filing a claim using the CMS 1500 form can be straightforward if you follow the requirements set by Regence Blue Cross Blue. This guide provides clear, step-by-step instructions to assist you in accurately completing the form online.

Follow the steps to successfully complete your claim form.

1. Use the ‘Get Form’ button to obtain the CMS 1500 claim form and open it in the editor.
2. In field 1, indicate the type of health insurance coverage applicable to the claim by checking the correct box.
3. Enter the insured’s identification number in field 1A. Ensure you input the three-digit alpha prefix and identification number exactly as shown on the member card.
4. Input the patient's name in field 2, entering their last name, first name, and middle initial if known, precisely as displayed on the member card.
5. In field 3, record the patient's birth date using the eight-digit format (MMDDCCYY) and select their gender by checking the appropriate box.
6. Field 4 requires you to enter the insured's name as shown on the member card. If the patient is the insured, write ‘same’.
7. Fill out the patient's complete address in field 5.
8. In field 6, specify the patient's relationship to the insured by checking self, spouse, child, or other.
9. Field 8 requires checking the appropriate box to indicate the patient status.
10. Complete field 9 with the other insured's name if applicable.
11. For field 9A, provide the policy or group number from the other insurance coverage.
12. Input the other insured's date of birth in field 9B using the eight-digit format (MMDDCCYY).
13. If applicable, enter the name of the employer or school in field 9C and the insurance plan name in field 9D.
14. Proceed to field 10, checking the appropriate boxes related to whether the patient’s condition is connected to another situation.
15. In field 11, document the insured's policy or FECA number as shown on their member card.
16. Continue completing each field accurately, following the specific instructions outlined for each section until all relevant information is entered.
17. Once all fields are filled in, review the form for accuracy.
18. Finally, you can save changes, download, print, or share the completed form as needed.

Start filling out your CMS 1500 claim form online today!