CMS 1500 – Helpful Claims Filing Hints
To prevent claims processing and payment delays, follow the claims filing hints below:
• Verify coverage. Groups often have changes in their health insurance benefit plans. Make reverifying
coverage through the Availity Health Information Network or the telephone self-service
option a routine part of your practice.
• Submit the entire member ID number including alpha prefix. Submit the member ID number not
the member’s Social Security number. Remember to correct your billing system when there are
changes.
• Complete all claim entry fields. To receive proper reimbursement, the claim information must be
completed in its entirety. Incomplete or inaccurate information will result in a claim denial.
• Enter the date of onset, if applicable. All ICD diagnosis codes in the 800-900 range require a date
of onset (injury, accident, first symptom, etc.).
• Use valid codes. CPT, HCPCS, and ICD codes are updated quarterly. Make sure you or your billing
service is using the most up-to-date codes.
• Report an unlisted code only if unable to find a procedure code that closely relates to or
accurately describes the service performed. Unlisted codes require documentation and therefore
cannot be submitted electronically.
• Use diagnosis codes that indicate a general medical exam when billing for “preventive” health
screening exams. Claims for these services will be denied if other diagnosis codes are used.
• Submit modifiers affecting reimbursement in the first and second position on claims. A
procedure code modifier, when applicable, provides important additional information about the service
performed.
• Submit multiple procedures on one claim. All procedures performed on the same date of service,
by the same provider for the same patient should be submitted on one claim.
• Submit all applicable diagnosis codes. Code to the highest level of specificity possible. Most 3-
digit codes require a fourth or fifth digit.
• Include the NPI for rendering physician and billing physician or group. Both the CMS-1500 and
UB-04 include fields for the NPI.
CMS-1500:
* Block 24J is for Type 1 NPIs (Rendering Physician)
* Block 32a is for Type 2 NPIs (Service Facility)
* Block 33a is for Type 1 or 2 NPIs (Billing Physician/Group)
The above blocks are split to allow your BCBSF provider number in the shaded area and your NPI in
the unshaded area labeled NPI.
To prevent claims processing and payment delays, follow the claims filing hints below:
• Verify coverage. Groups often have changes in their health insurance benefit plans. Make reverifying
coverage through the Availity Health Information Network or the telephone self-service
option a routine part of your practice.
• Submit the entire member ID number including alpha prefix. Submit the member ID number not
the member’s Social Security number. Remember to correct your billing system when there are
changes.
• Complete all claim entry fields. To receive proper reimbursement, the claim information must be
completed in its entirety. Incomplete or inaccurate information will result in a claim denial.
• Enter the date of onset, if applicable. All ICD diagnosis codes in the 800-900 range require a date
of onset (injury, accident, first symptom, etc.).
• Use valid codes. CPT, HCPCS, and ICD codes are updated quarterly. Make sure you or your billing
service is using the most up-to-date codes.
• Report an unlisted code only if unable to find a procedure code that closely relates to or
accurately describes the service performed. Unlisted codes require documentation and therefore
cannot be submitted electronically.
• Use diagnosis codes that indicate a general medical exam when billing for “preventive” health
screening exams. Claims for these services will be denied if other diagnosis codes are used.
• Submit modifiers affecting reimbursement in the first and second position on claims. A
procedure code modifier, when applicable, provides important additional information about the service
performed.
• Submit multiple procedures on one claim. All procedures performed on the same date of service,
by the same provider for the same patient should be submitted on one claim.
• Submit all applicable diagnosis codes. Code to the highest level of specificity possible. Most 3-
digit codes require a fourth or fifth digit.
• Include the NPI for rendering physician and billing physician or group. Both the CMS-1500 and
UB-04 include fields for the NPI.
CMS-1500:
* Block 24J is for Type 1 NPIs (Rendering Physician)
* Block 32a is for Type 2 NPIs (Service Facility)
* Block 33a is for Type 1 or 2 NPIs (Billing Physician/Group)
The above blocks are split to allow your BCBSF provider number in the shaded area and your NPI in
the unshaded area labeled NPI.