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

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Page 1: Copyright © 2008 Waiting Room Solutions Billing Training: CMS 1500 Form and Electronic Claims Submission Basics

Copyright © 2008 Waiting Room Solutions

Billing Training: CMS 1500 Form and Billing Training: CMS 1500 Form and Electronic Claims Submission BasicsElectronic Claims Submission Basics

Page 2: Copyright © 2008 Waiting Room Solutions Billing Training: CMS 1500 Form and Electronic Claims Submission Basics

Copyright © 2008 Waiting Room Solutions

CMS 1500

1.Form used by a non-institutional provider to submit a claim2.Terms: CMS and HCFA3.Electronic format for submission is the 837 message

Page 3: Copyright © 2008 Waiting Room Solutions Billing Training: CMS 1500 Form and Electronic Claims Submission Basics

Copyright © 2008 Waiting Room Solutions

837 Message1.Message that is sent from Waiting Room Solutions to Clearinghouse2.Has the same data as the CMS 15003.Clearinghouse then sends the 837 message to the insurance company for payment

Page 4: Copyright © 2008 Waiting Room Solutions Billing Training: CMS 1500 Form and Electronic Claims Submission Basics

Copyright © 2008 Waiting Room Solutions

Insurance Categories1.There is only one insurance category per insurer2.An Insurance Category is defined by a unique submitter ID through the Clearinghouse3.Insurance Categories contain Insurance Packages

Page 5: Copyright © 2008 Waiting Room Solutions Billing Training: CMS 1500 Form and Electronic Claims Submission Basics

Copyright © 2008 Waiting Room Solutions

Insurance Packages1.Insurance Packages are defined by a unique address for that insurer2.There may be multiple insurance packages for an insurer3.Insurance Packages only become relevant with paper claims4.Waiting Room Solutions users select insurance packages and they are associated with insurance categories

Page 6: Copyright © 2008 Waiting Room Solutions Billing Training: CMS 1500 Form and Electronic Claims Submission Basics

Copyright © 2008 Waiting Room Solutions

Page 7: Copyright © 2008 Waiting Room Solutions Billing Training: CMS 1500 Form and Electronic Claims Submission Basics

Copyright © 2008 Waiting Room Solutions 013007NA

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