Decorative arrowsHMSA Provider Resource Center
HomeNews and AlertsE-LibraryMedicare E-LibraryCommunications ArchiveQUEST Integration
Frequently Asked QuestionsUseful Web SitesContacting HMSA
HMSA Logo
 

CMS 1500 Claim Form - General Instructions

CMS 1500 Claims Filing Instructions - Interactive CMS 1500 Claim Form

Below is a link to HMSA's interactive version of the CMS 1500 claim form. The document includes instructions applicable to all HMSA lines of business. Adobe Reader or another PDF-reader application is required to view the document. Please note that providers may not submit claims on printouts of the interactive form. Any claims submitted on printouts of the interactive form will be rejected.

 

 

To view the instructions for a particular CMS 1500 block, simply click on the block number. A text window containing the block's instructions will appear on your screen. Instructions also appear, in a truncated format, anytime you move the cursor over a field number. However, clicking on the field number displays the instructions in a more user-friendly way.

 

If you wish, you can move a block's instructions window by clicking at the top or bottom and dragging (moving the mouse while holding down the left mouse button). To resize the window, click in the lower right corner and drag. Any changes you make will be retained until you close the PDF-reader application.

 

CMS 1500 Claims Filing Instructions

The following instructions are applicable to CMS 1500 claims filing for HMSA's basic plans and 65C Plus. The numbers on the left refer to the fields on the claim form. Indicators are also included that designate whether the field is (R)equired, (C)onditionally required, (O)ptional or (N)ot applicable for HMSA claims processing.

 

Designation Table

 

Designation Description Explanation

R

Required The information must always be provided. Claims submitted with the information missing may be returned to the submitter or there may be a processing delay while the information is obtained.

C

Conditionally

Required

The information must always be provided when the condition is present. Claims submitted with the information missing may be returned to the submitter or there may be a processing delay while the information is obtained.

O

Optional The information is helpful but not necessary for prompt processing.

N/A

Not Applicable The information is not used.

 

 

To view previous versions, see:

CMS 1500 Claim Form - Differences Between HMSA Plans and Out-of Area Plans - OBSOLETE

CMS 1500 Claim Form - Differences Between HMSA Plans and Out-of-Area Plans - OBSOLETE (Home IV Therapy version)

CMS 1500 Claim Form - General Instructions - OBSOLETE

CMS 1500 Claim Form - Instructions for Out-of-Area BCBS Members - OBSOLETE

 

First Published:08/02/2006
Latest Revision:01/06/2016
Back to Top

Files that are in PDF format can be viewed using the free Adobe Reader or another PDF-reader application.

Decorative arrowsHomeNews and AlertsE-LibraryMedicare E-LibraryCommunications ArchiveQUEST IntegrationFrequently Asked QuestionsUseful Web SitesContacting HMSA

Non-discrimination notice

Need a language interpreter?

ʻŌlelo Hawaiʻi | Bisaya | 繁體中文 | Ilokano | 日本語 | 한국어 | ພາສາລາວ | Kajin Ṃajōḷ | Lokaiahn Pohnpei | Gagana Sāmoa | Español | Tagalog | Tonga | Foosun Chuuk | Tiếng Việt