Get Guide For Completing Cms-1500 Form - Bcbsmt

Completing the CMS-1500 form accurately is essential for efficient claims processing for patients with BlueShield coverage. This guide offers clear, step-by-step instructions to help ensure that you fill out the form correctly when submitting online.

Follow the steps to complete the CMS-1500 form successfully.

1. Click ‘Get Form’ button to access the CMS-1500 form and open it in your preferred editing tool.
2. In Section 1, select ‘Other’ to indicate you are submitting a Blue Shield claim. This ensures the claim is routed correctly for processing.
3. In field 1A, enter the insured ID number from the Blue Cross and Blue Shield ID card of the subscriber.
4. For field 2, fill in the patient's name using the format: last name, first name, and middle initial.
5. In field 3, provide the patient's birth date (MM/DD/CCYY) and select their gender.
6. Enter the insured's name in field 4, following the same naming format as field 2.
7. Complete field 5 with the patient’s permanent mailing address and telephone number.
8. For field 6, select the appropriate relationship of the patient to the insured.
9. If the insured's address differs from the patient's, complete field 7 with their permanent mailing address.
10. In field 20, indicate whether the claim includes charges for lab services performed outside of the physician's office by selecting 'Yes' or 'No'. If 'Yes', provide the total charges.
11. For field 21, enter the diagnosis codes in the ICD-9-CM format, ensuring to list the primary diagnosis first.
12. In fields 24A through 24F, enter the dates of service, place of service codes, procedure/services codes, diagnosis pointers, and charges respectively.
13. Make sure to fill in the total charge for all services in field 28.
14. Before submitting the form, review all entered data for accuracy to avoid processing delays.
15. Once you have completed your review, save changes, download, print, or share the completed form as needed.

Complete your CMS-1500 forms online for efficient processing and claim management.