Thank god you get straight to the point, I was watching this one video trying to learn better understanding on A/R reports and this lady was soo off topic at times I was wandering why I was even watching the video. You get straight to point and easy to understand and learn. Thank you!!
Thank you! You may have just saved us months of back and forth. My provider gave me a half completed sheet and I think they need to reissue us a new one. FYI, for laypeople like me, it could be really useful to explain the acronyms that you're using as well, or maybe make a video specifically for regular people who are trying to make sure their forms are filled out properly before they send things off to their insurance.
Thank you so much, I have to accomplish submitting this, and I had just read printing the 1500 in color might be rejected due to exact color of red not matching, so I needed your video and advise to call the individual p0rivider services to see if they accept a black and white version.
i am on the insurance side of things, manage medicaid benefits. i get calls from providers, mostly 3rd party billers, checking claims status. i got my cpc in 2011 and tried to get into medical providers, hospitals, drs offices as a level 1 coder. Not one provider would give me a chance to come and learn from an experienced person. Very disappointing!! How the hell do you get the experience if no one gives you that first chance??? I temped on the insurance side and have been doing it ever since. i would still like to do charge entry. have been remote for 4 yrs now
So I’m a student and we use the sims claim simulator and like it marks it wrong if you put in the patient’s phone number and when you use the f date thing the qualifier is a code. Also where on the record do you find if they accept assignment?
Newly certified graduate here, I never really managed to figure out diagnosis pointers and was hoping that someone could reexplain them to me, please advise. Does each diagnosis pointer correspond to a procedural code as it relates to each diagnosis? For example, if ICD-10 code A is what proves the medical necessity of CPT code A, does CPT code A's diagnosis pointer then need to be labeled as "A" because it is connected to the first procedure performed as a result of the first/primary diagnosis? And if, continuing along that trend, ICD-10 code B is related to CPT code B in the exact same way, should CPT code B's diagnosis pointer then be labeled as "B"?
@@KayeSimmons-w5k whether the claim is in or out of network, box 12, 13 and 31 are all “signature on file”. The only exception is if the provider is out of network and the patient is self pay, leave box 13 blank so the insurance reimbursement is sent to the member, not to the provider.
Hi I am new to the medical billing world and am stepping in at a local chiropractic office. I have a quick question about line 26, the patient's account number- does that refer to their account with the insurance company? Thank you for your videos and support!
If you do not fill in box J shaded area and the qualifier, your claim will be denied if it goes on paper. so taxonomy in needed and qualifier is needed
The form doesn't look like this anymore. For instance line item #31 has like 20 to 30 boxes now I don't know what to do with. I wish there was a single class I could take on how to fill out this form. The 2021 version. Thanks for the help though!
Hi. The CMS 1500 form does look like this! There is no "2021" version. Box 31 is "signature of physician or supplier". What exactly are you confused about? Happy to help.
The new online version of the CMS 1500 (the one officeally supplies) there are differences between the current form that you are referencing and that version. I am not sure if Medicare recently changed the way the form is filled out but Box 31 does not just say signature of physician or supplier. There are a lot more boxes to check or fill out, there are about 30. Please have a look if you are able and you will see what I am talking about. Thanks!
@@tysonarden4642 I don't see a new form in Office Ally. You are welcome to email me a copy of what you are referring to. There aren't different versions of the CMS 1500 form. Thanks.
Are we able to submit the 11 (office loc code) with a 95 modifier? One company is saying that they allow telehealth but will only approve location 11 for all sessions. They deny telehealth loc codes.
question...if I am doing outpatient physical therapy in the patient home, what do I put as the facility where service take place on the 1500. Do I put the patient home address?
@@sherrychang2551 nothing is entered in box 22 for a secondary claim. that box is used to correct or void a claim. ask the insurance which claim form they accept. some only accept the original red and white form. others may allow the claim to be printed in black and white on copy paper.
The ICD indicator will always be 0 now? Also, I bought some claim forms from an office supply store. They're attached (top & bottom) copies but don't seem to transfer 'carbon' copying. Can I just use the underneath form if I mess up on the top one?
Hi! Yes, the ICD indicator will always be 0 (for ICD10 code). I have never purchased duplicate or triplicate forms. I am not sure if the form underneath is acceptable. You can purchase single forms going forward. Thanks for watching!
Enter the billing provider's information in box 33. Enter the facility information in box 32. If the service took place in an office or the patient's home, you can skip box 32.
@@alexiscarrillo8901 can a dentist bill medical insurance? yes. If they provide a medically necessary service and the patient has benefits for the service the dentist may be reimbursed.
Do insurance companies accept downloadable versions? If I print it on an actual form with just the content, how can I get my printer to adjust correctly? I have tried to print from 2 different sites but the content does not match the boxes.
A lot of insurance payers do allow you to print the CMS 1500 form on regular copy paper in black and white. Just call provider services to confirm that they allow copy paper in place of the original red and white form and the correct mailing address. If you are having alignment issues you'll need someone to help fix the settings. Maybe someone from IT?
@@AskTheBiller I just realized that you mentioned that insurance companies may accept black & white copies. Is it not acceptable to print the form in color?
CMS - Apply for Medicare and Medicaid Enrollment. After waiting for 6 months and/or in-between, you'll have to wait for a PTAN number provided by the state. Find out who your MAC is and send in a copy of CMS 855A form, you'll be contacted to submit additional verifications and go from there. Once you get a PTAN number request for your EDI.
Hi Lisa. If you’re submitting a claim for services rendered prior to when the patient passed away, nothing changes. The “date of service” is what the insurance takes into consideration.
I did a quick google search and this is what I found. Hope it helps! When billing for monaural hearing aids, a RT or LT modifier in the second modifier field is required for payment. Claims submitted without the RT or LT modifier may be denied. When billing for a binaural hearing aid the RT or LT modifier is not required. Claims submitted with a RT or LT modifier will be denied as inappropriately billed.
I am billing for a surgery. The patient has Medicare. A 55 modifier was applied. I am needing to submit the assumed or relinquished date of the postoperative care in the documentation field and the number of postoperative days in the days/units field. Can you please tell me which box is considered the documentation field?
Hi Joe. If the patient is the insured, you don't have to complete fields 2 & 5, but I always do. When I print a paper claim from the practice management software those fields always generate.
@@AskTheBiller Thank you so much for clarifying this to me. I have to submit my form to my teacher Monday and I over thought myself LOL,, I didn't know what the heck to do! Thank you so much for putting videos like this out there. It helps us guys in school sooo much.. Bless you and thank you !!!!
Diagnosis pointers have nothing to do with the specialty. The diagnosis pointer links the diagnosis to the charge. So it tells the insurance company the reason why (diagnosis) the provider is billing for the service (CPT/HCPCS).
Hi I really love your videos, and it's helped me a lot. I was wondering is there a video to do a Secondary claim manually and submit to payers by mail. I am not to confident on how to do that manually, as some of the pt secondary only accept mail in. Best,
Hi David. Thanks for supporting my channel! The process is the same for secondary claims. The only thing you need to do is attach a copy of the primary insurance EOB along with the claim form.
Complete box 10 if the claim is related to workers’ compensation, an automobile accident or other accident. I skipped this box in error. I should have marked “no”for all 3 since the claim was not related to an accident. Thanks for watching!
So I am new to 1500 forms but I have a problem.... On box 31 you said to write SIG ON FILE and the date. The problem is that the digital form, even if I use only a 2 digit date, cuts off the last number. You need 6 spaces for a date, for example today is 021222 but it only has enough room for 02122. What am I missing please and thank you?!
You're welcome! Yes, you can call the insurance payer and speak with provider services to confirm receipt of the claim and if it is processing. Or you can check the claim status on their portal/website.
@@ChristianChicDez Hi! An NPI is an identification number issued by CMS. Having an NPI doesn’t mean you are in network with an insurance company. To become in network, the required process is called provider/payer enrollment. And it’s done with each insurance company.
Hi~ I have a question about this. I recevied the form in my mailbox, provider is Pidemont hospital, and I wonder what is the form meaning for me? I need pay money to hospital or insurance company? or I need to tell insurance company I got the form and they will give me money. Pls let me know. Thank you.
Hi Shuhang. The hospital mailed you a claim form? Claims forms are submitted to insurance companies for reimbursement. If you are self pay and paid for services in full out of pocket you can submit a claim for reimbursement directly from the insurance company. If you have insurance coverage and you were billed for patient responsibility you would not submit a claim for that because the provider has already submitted one. Does this make sense?
I’m about two weeks away from taking my huge certification test. At one point, if I wasn’t bald I would’ve ripped the rest of the hair out of my head LOL good luck!
Your video is so helpful! I am a new biller for doctors office and pharmacy for PIP claims. Do I put my info (my billing company’s name and address) in box 33?
Thank you! No, box 33 should have the billing provider information. That may be a group or individual provider. Enter the name address and NPI. Whoever the claim should be payable to!
@@AskTheBiller thank you for taking the time to reply! Are the payments (checks) and correspondence (EOBs) sent to provider or to the biller (me) and recorded and then sent to provider?
Thank god you get straight to the point, I was watching this one video trying to learn better understanding on A/R reports and this lady was soo off topic at times I was wandering why I was even watching the video. You get straight to point and easy to understand and learn. Thank you!!
Thanks so much! I can’t stand fluff and chatter.🥴😂
Thank you for being professional and straight to the point.
You’re very welcome. I can’t stand when a video doesn’t get right to it!🥴😂
Awesome and straight forward. Thank you!
You're very welcome!
Thank you so much for breaking this down into digestible bites!
@@AmandaAllmon-c2s you’re welcome 😊
Thank you! You may have just saved us months of back and forth. My provider gave me a half completed sheet and I think they need to reissue us a new one. FYI, for laypeople like me, it could be really useful to explain the acronyms that you're using as well, or maybe make a video specifically for regular people who are trying to make sure their forms are filled out properly before they send things off to their insurance.
You’re welcome! And thank you so much for your feedback. I’ll be sure to explain the acronyms when I create the next claim form tutorial. 😊
@@AskTheBiller You're an angel! Thank you!
Thank you so much, I have to accomplish submitting this, and I had just read printing the 1500 in color might be rejected due to exact color of red not matching, so I needed your video and advise to call the individual p0rivider services to see if they accept a black and white version.
Is box 32 for when you enter the name of the place of where services was rendered? What’s the difference between box 32 and 33 please?
Yes, box 32 is the service location (ex: hospital). Box 33 is for billing provider information. This is who the check will be payable to.
I just want to thank you for this- I am so appreciative!!!
@@user-ru5ui9xv6y you’re very welcome 😊
I have a question, How do you come up with the units to bill for case management? Thank you for the video, very easy.
if i sent the claim manually to primary payer should so how may i create claim number ???
Thank you so much!!! 🌟🌟🌟🙏🏻 I just graduated from CMAA and this is great info 👍🏻
if under medicaid, but Medicaid use BCBS plan, which box we should check? Medicaid or Group?
i am on the insurance side of things, manage medicaid benefits. i get calls from providers, mostly 3rd party billers, checking claims status. i got my cpc in 2011 and tried to get into medical providers, hospitals, drs offices as a level 1 coder. Not one provider would give me a chance to come and learn from an experienced person. Very disappointing!! How the hell do you get the experience if no one gives you that first chance??? I temped on the insurance side and have been doing it ever since. i would still like to do charge entry. have been remote for 4 yrs now
So I’m a student and we use the sims claim simulator and like it marks it wrong if you put in the patient’s phone number and when you use the f date thing the qualifier is a code. Also where on the record do you find if they accept assignment?
Newly certified graduate here, I never really managed to figure out diagnosis pointers and was hoping that someone could reexplain them to me, please advise. Does each diagnosis pointer correspond to a procedural code as it relates to each diagnosis?
For example, if ICD-10 code A is what proves the medical necessity of CPT code A, does CPT code A's diagnosis pointer then need to be labeled as "A" because it is connected to the first procedure performed as a result of the first/primary diagnosis? And if, continuing along that trend, ICD-10 code B is related to CPT code B in the exact same way, should CPT code B's diagnosis pointer then be labeled as "B"?
That’s correct. You’re simply linking the service/procedure (what was done = CPT or HCPCS code) to the diagnosis (why it was done = ICD10CM code).
I have a experience related this data vertical can you provide a individual project which means insurance. Cpt and dx . Dos pages
If this was an out of network what would you enter versus SIG ON FILE?
@@KayeSimmons-w5k whether the claim is in or out of network, box 12, 13 and 31 are all “signature on file”. The only exception is if the provider is out of network and the patient is self pay, leave box 13 blank so the insurance reimbursement is sent to the member, not to the provider.
Hello, I was wondering if it is legal to bill a claim if there is no signature on file for release of medical records (box 12 of the HCFA)
Is there at URL for this template please ? Where do I find this form to fill out on the computer. Thank you.
Yes, send me an email at askthebiller@gmail.com and I’ll reply with the link!
Hi I am new to the medical billing world and am stepping in at a local chiropractic office. I have a quick question about line 26, the patient's account number- does that refer to their account with the insurance company? Thank you for your videos and support!
Hi! That’s the patient’s account number in the PMS, practice management software, or their MRN, medical record number.
If you do not fill in box J shaded area and the qualifier, your claim will be denied if it goes on paper. so taxonomy in needed and qualifier is needed
The form doesn't look like this anymore. For instance line item #31 has like 20 to 30 boxes now I don't know what to do with. I wish there was a single class I could take on how to fill out this form. The 2021 version. Thanks for the help though!
Hi. The CMS 1500 form does look like this! There is no "2021" version. Box 31 is "signature of physician or supplier". What exactly are you confused about? Happy to help.
The new online version of the CMS 1500 (the one officeally supplies) there are differences between the current form that you are referencing and that version. I am not sure if Medicare recently changed the way the form is filled out but Box 31 does not just say signature of physician or supplier. There are a lot more boxes to check or fill out, there are about 30. Please have a look if you are able and you will see what I am talking about. Thanks!
@@tysonarden4642 I don't see a new form in Office Ally. You are welcome to email me a copy of what you are referring to. There aren't different versions of the CMS 1500 form. Thanks.
Are we able to submit the 11 (office loc code) with a 95 modifier? One company is saying that they allow telehealth but will only approve location 11 for all sessions. They deny telehealth loc codes.
Yes! I bill POS 11 with modifier 95 for telehealth.
@@AskTheBiller I appreciate it!!
question...if I am doing outpatient physical therapy in the patient home, what do I put as the facility where service take place on the 1500. Do I put the patient home address?
Hi! I'm not a physical therapy biller but feel free to ask this question in my Facebook group facebook.com/groups/askthebiller/
Is this the form patients fill out when requesting reimbursement for out of network fees for services?
Hi Leesa. Yes, patient's complete this claim form for out of network reimbursement.
How do you do your billing electronically?
Billing software and clearinghouses allow us to create claims and transmit them electronically to insurance payers.
Do you know to submit a claim for secondary insurance claims?
@@sherrychang2551 the same way! just also attach a copy of the primary insurance EOB.
Thanks so much! Do you know what to put on for box 22? And do the hcfa have to be on red? I have a black and white form that’s filled out already
@@sherrychang2551 nothing is entered in box 22 for a secondary claim. that box is used to correct or void a claim. ask the insurance which claim form they accept. some only accept the original red and white form. others may allow the claim to be printed in black and white on copy paper.
This was so helpful! Thank you! Happy new year!
@@sherrychang2551 🫶🏾
I have SCA for out of network services how often can I bill? Every month or every 2 weeks
This was perfect thank you
You’re welcome ❤
Can you do a video explaining the bottom section of this form? As far as the diagnosis pointers, place of service numbers, etc.
Sure! I will create a new tutorial and go deeper into detail. Stay tuned.🙂
The ICD indicator will always be 0 now? Also, I bought some claim forms from an office supply store. They're attached (top & bottom) copies but don't seem to transfer 'carbon' copying. Can I just use the underneath form if I mess up on the top one?
Hi! Yes, the ICD indicator will always be 0 (for ICD10 code). I have never purchased duplicate or triplicate forms. I am not sure if the form underneath is acceptable. You can purchase single forms going forward. Thanks for watching!
@@AskTheBiller Thank you for helping! :)
If you are the provider and the biller to you need to populate your information twice in the last two boxes?
Enter the billing provider's information in box 33. Enter the facility information in box 32. If the service took place in an office or the patient's home, you can skip box 32.
Hi thank you so much for the excellent video. Question, is there a way to import data to fill in this form, from csv file, excel, ms access, etc?
You're welcome, Gary. That is a great question but I am not sure. Thanks for watching!
Would this work for doing NEMT Transportation? I am still learning how to do this for Medicare and other private insurance.
Yes! You would use this CMS 1500 claim form for NEMT billing.
@@AskTheBiller Thank you I finally got my papers in today. So now watching your video again.
Can a dental provider bill a health insurance?
@@alexiscarrillo8901 can a dentist bill medical insurance? yes. If they provide a medically necessary service and the patient has benefits for the service the dentist may be reimbursed.
@@AskTheBillerwill I bill it like this ? With this form ?
How about claim number?? If i fill this form manually like in this video
Do insurance companies accept downloadable versions? If I print it on an actual form with just the content, how can I get my printer to adjust correctly? I have tried to print from 2 different sites but the content does not match the boxes.
A lot of insurance payers do allow you to print the CMS 1500 form on regular copy paper in black and white. Just call provider services to confirm that they allow copy paper in place of the original red and white form and the correct mailing address. If you are having alignment issues you'll need someone to help fix the settings. Maybe someone from IT?
@@AskTheBiller Thanks a bunch!!
@@4evermysterious You're welcome!
@@AskTheBiller I just realized that you mentioned that insurance companies may accept black & white copies. Is it not acceptable to print the form in color?
@@4evermysterious I’ve never printed the form in color. Always double check with the payer directly what they will and will not accept!
I am new to submitting claims to insurance. How do you submit and electronic claim? Do you have to use a certain software or where do I go to do this?
CMS - Apply for Medicare and Medicaid Enrollment. After waiting for 6 months and/or in-between, you'll have to wait for a PTAN number provided by the state. Find out who your MAC is and send in a copy of CMS 855A form, you'll be contacted to submit additional verifications and go from there. Once you get a PTAN number request for your EDI.
How do I fill out the claim if the client has passed away?
Hi Lisa. If you’re submitting a claim for services rendered prior to when the patient passed away, nothing changes. The “date of service” is what the insurance takes into consideration.
@@AskTheBiller Thank you so much for the information!
@@lisalang6662 You’re very welcome! Happy to help.
i need help billing 2 hearing aids keep getting denied please help saying wrong moodifier
I did a quick google search and this is what I found. Hope it helps!
When billing for monaural hearing aids, a RT or LT modifier in the second modifier field is required for payment. Claims submitted without the RT or LT modifier may be denied.
When billing for a binaural hearing aid the RT or LT modifier is not required. Claims submitted with a RT or LT modifier will be denied as inappropriately billed.
I am billing for a surgery. The patient has Medicare. A 55 modifier was applied. I am needing to submit the assumed or relinquished date of the postoperative care in the documentation field and the number of postoperative days in the days/units field. Can you please tell me which box is considered the documentation field?
Also which field is the days/units field? Thank you so much for your help.
how do i fill the form out if their is a claim number from an accident
Hi Kayla. You can put the accident claim number at the very top of the claim form and in box 19.
I thought that if the patient and insured were the same, you didnt have to do the patient fields?
Hi Joe. If the patient is the insured, you don't have to complete fields 2 & 5, but I always do. When I print a paper claim from the practice management software those fields always generate.
@@AskTheBiller Thank you so much for clarifying this to me. I have to submit my form to my teacher Monday and I over thought myself LOL,, I didn't know what the heck to do! Thank you so much for putting videos like this out there. It helps us guys in school sooo much.. Bless you and thank you !!!!
Can you please tell me the different between 11 and 9.
@@Artist-r1n 11 is for the primary insurance group number. 9a is for the secondary insurance policy number.
How can we find this is primay or secondary mam
What is the diagnosis pointer for home health
Diagnosis pointers have nothing to do with the specialty. The diagnosis pointer links the diagnosis to the charge. So it tells the insurance company the reason why (diagnosis) the provider is billing for the service (CPT/HCPCS).
Hi I really love your videos, and it's helped me a lot.
I was wondering is there a video to do a Secondary claim manually and submit to payers by mail. I am not to confident on how to do that manually, as some of the pt secondary only accept mail in.
Best,
Hi David. Thanks for supporting my channel! The process is the same for secondary claims. The only thing you need to do is attach a copy of the primary insurance EOB along with the claim form.
How would you summarize the process of gathering information to complete a claim form?
May I asked why wasn't box 10 filled out?
Complete box 10 if the claim is related to workers’ compensation, an automobile accident or other accident. I skipped this box in error. I should have marked “no”for all 3 since the claim was not related to an accident. Thanks for watching!
How to reduce errors related to provider selection in medical billing can you give me some ideas
thanks for the information, where can I download a free copy of the claim form.
Here you go 😊 CMS-1500 Template www.cigna.com/static/www-cigna-com/docs/form-cms1500.pdf
So I am new to 1500 forms but I have a problem.... On box 31 you said to write SIG ON FILE and the date. The problem is that the digital form, even if I use only a 2 digit date, cuts off the last number. You need 6 spaces for a date, for example today is 021222 but it only has enough room for 02122. What am I missing please and thank you?!
Thanks for this - once I mail them, is there a way we can track to ensure they received it and are working on?
You're welcome! Yes, you can call the insurance payer and speak with provider services to confirm receipt of the claim and if it is processing. Or you can check the claim status on their portal/website.
Hi. Anything mailed out should be certified… always get a tracking number
Thank you so much❤😊 👏🙏🙏🙏
Hi I’m new here does having a npi put you in network
@@ChristianChicDez Hi! An NPI is an identification number issued by CMS. Having an NPI doesn’t mean you are in network with an insurance company. To become in network, the required process is called provider/payer enrollment. And it’s done with each insurance company.
Can't wait to take your training 😉
Thank you!!
Hi~ I have a question about this. I recevied the form in my mailbox, provider is Pidemont hospital, and I wonder what is the form meaning for me? I need pay money to hospital or insurance company? or I need to tell insurance company I got the form and they will give me money. Pls let me know. Thank you.
Hi Shuhang. The hospital mailed you a claim form? Claims forms are submitted to insurance companies for reimbursement. If you are self pay and paid for services in full out of pocket you can submit a claim for reimbursement directly from the insurance company. If you have insurance coverage and you were billed for patient responsibility you would not submit a claim for that because the provider has already submitted one. Does this make sense?
Thanks' you way of talking easy❤
Do you have to put the providers phone number or is that optional please help me out.
Yes, in box 33.
@@AskTheBiller thanks you’re awesome
I doing this in college, I still need a bit of practice 🙃. I don't want to make no mistakes
Hi Flor. Thanks for watching! And practice makes perfect : )
I’m about two weeks away from taking my huge certification test. At one point, if I wasn’t bald I would’ve ripped the rest of the hair out of my head LOL good luck!
Your video is so helpful! I am a new biller for doctors office and pharmacy for PIP claims. Do I put my info (my billing company’s name and address) in box 33?
Thank you! No, box 33 should have the billing provider information. That may be a group or individual provider. Enter the name address and NPI. Whoever the claim should be payable to!
@@AskTheBiller thank you for taking the time to reply! Are the payments (checks) and correspondence (EOBs) sent to provider or to the biller (me) and recorded and then sent to provider?
@@glindacholak2205 the checks and EOBs are sent to the provider! then they will forward them to you for review and to post the payments.
@@AskTheBiller you are a blessing! Thank you for your help!💕
Please give me project detail
Is this charge entry??? Pls rly
Hi. This is more than charge entry.
@@AskTheBiller
Thank for ur rly😊... Pls can u tell me this process name
@@suguna.lalitha2638claims processing
HOW TO JOIN THIS JOB KINDLY HELPING ME
Is this usa form?
I keep getting the name part incorrect
Which box are you referring to?
thank you!
You’re welcome 😉
I now cms 1500 claim form
How to get this kind of job
Insurance can be such a hassle. We know as providers they love to deny claims and save money so thanks for helping with this.
You’re very welcome!
Hi I keep getting my homework assignment wrong and i did it this way 🙃
I did my this way and got 8 mistakes wrong with 73%😢
👍
I need help ☹️
How may I help you Karla? What questions do you have?
@@AskTheBiller Can i email you to ask you properly ☹️
Sure you can! askthebiller@gmail.com
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