Copyright © 2008 Waiting Room Solutions Billing Training: CMS 1500 Form and Electronic Claims Submission Basics.

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Presentation transcript:

Copyright © 2008 Waiting Room Solutions Billing Training: CMS 1500 Form and Electronic Claims Submission Basics

Copyright © 2008 Waiting Room Solutions CMS Form used by a non-institutional provider to submit a claim 2.Terms: CMS and HCFA 3.Electronic format for submission is the 837 message

Copyright © 2008 Waiting Room Solutions 837 Message 1.Message that is sent from Waiting Room Solutions to Clearinghouse 2.Has the same data as the CMS Clearinghouse then sends the 837 message to the insurance company for payment

Copyright © 2008 Waiting Room Solutions Insurance Categories 1.There is only one insurance category per insurer 2.An Insurance Category is defined by a unique submitter ID through the Clearinghouse 3.Insurance Categories contain Insurance Packages

Copyright © 2008 Waiting Room Solutions Insurance Packages 1.Insurance Packages are defined by a unique address for that insurer 2.There may be multiple insurance packages for an insurer 3.Insurance Packages only become relevant with paper claims 4.Waiting Room Solutions users select insurance packages and they are associated with insurance categories

Copyright © 2008 Waiting Room Solutions Aetna (Category) Submitter ID Aetna (Package 1) El Paso TX Aetna (Package 2) Lexington KY Aetna (Package 3) Allentown PA Aetna (Package 4) San Diego CA

Copyright © 2008 Waiting Room Solutions NA

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