Michigan Form CMS-1500 is a standardized version of the Health Insurance Claim Form used for submitting claims to Medicaid for reimbursement. It is also known as the National Uniform Claim Form and is used by medical providers in the state of Michigan to submit paper claims for reimbursement. The form is used for medical services provided to Medicaid beneficiaries. There are two types of Michigan Form CMS-1500: the original version and the revised version. The original version is used for claims that predate October 1, 2019, while the revised version is for claims submitted on or after October 1, 2019. The form must be completed in full and signed by both the provider and patient, and any supporting documentation must be included with the claim.
Michigan Form CMS-1500
Description
How to fill out Michigan Form CMS-1500?
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FAQ
Submission of the CMS 1500 (02/12) claim form should either be typed or computer printed forms. Handwritten forms can cause delays and errors in processing and slow down time for reimbursement. Ensure to use all capital typeface with Courier New or Tines New Roman font style and size 10.
How to print your CMS 1500 form. After saving your claim form, you can submit it electronically through SimplePractice, or download it to print.
How to fill out a CMS-1500 form The type of insurance and the insured's ID number. The patient's full name. The patient's date of birth. The insured's full name, if applicable. The patient's address. The patient's relationship to the insured, if applicable. The insured's address, if applicable. Field reserved for NUCC use.
The Form CMS-1500 is the standard paper claim form to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed. In addition to billing Medicare, the 837P and Form CMS-1500 may be suitable for billing various government and some private insurers.
In SimplePractice, you can generate CMS 1500 claim forms to submit electronically through the system, or download and print to submit outside the system.
In order to purchase claim forms, you should contact the U.S. Government Printing Office at 1-866-512-1800, local printing companies in your area, and/or office supply stores. Each of the vendors above sells the CMS-1500 claim form in its various configurations (single part, multi-part, continuous feed, laser, etc).
To print text only on a blank, pre-existing CMS 1500 form: Navigate to the Claims module and select Claims Manager. Select the claims to be exported. Click the Actions. drop-down and select Export/Download. Select CMS 1500 (PDF) from the drop-down and click Export.