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.

Interactive CMS-1500 form (version 02-12) [PDF]

Note: You must download the form to experience its interactive features.

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.

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