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 except the HMSA Plan for QUEST Members. Adobe Reader or another PDF-reader application is required to view the document.

 

Interactive CMS Claim 1500 Form (685 KB)

 

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