The Most Important Medical Billing Forms

Medical billing forms are part of standardized billing processes that ensure that medical professionals and institutions are paid for their services. Claims forms are widely considered as the most important of the various forms medical billers will encounter during the billing process, since they function as an invoice, or request for payment, submitted to a patient’s designated payer – generally government or private health insurance. Here we’ll get into the details of the two main claims forms used in claims submissions, the CMS-1500 and the UB-04.

Medical billing claims forms are used to bill payers for all aspects of patient care. Medical billers fill out these forms, which are most frequently submitted electronically, but may, under some circumstances, be submitted in hard copy, or paper, form. These forms contain all the information payers need to evaluate and process a patient’s claim, including patient demographic information, insurance information, diagnostic and procedure codes and itemized charges for each procedure.

The CMS-1500 form and the 837-P

These are the standard forms that the Centers for Medicare and Medicaid Services (CMS) require non-institutional healthcare professionals, like doctor’s offices, to use for Medicare claims submissions. They are also widely accepted by other government and commercial payers.

What is the CMS-1500? It is the paper version of this claim form, which is used by medical offices that are still submitting claims manually to payers. It is printed in red ink on a white background, and medical billers must use the official forms approved by CMS, which are available from the US Government Printing Office, office supply stores and many local printing companies across the country. The 837-P (professional) is the electronic version of the CMS-1500, the standard format that healthcare professionals must use in transmitting health care claims electronically to Medicare, as well as other government and private insurers. Complete instructions for the CMS-1500 can be found in Chapter 26 of the Medicare Claims Processing Manual (PDF).

The UB-04 form and the 837-I

These are the standard forms that CMS require institutional healthcare providers, like hospitals, to use for Medicare claims submissions. Like the CMS-1500, these too are also widely accepted for claims submitted to other government health insurers, as well as private payers.

The UB-04 form, also called the CMS-1450 is the paper version of the form, which is used in manual claims submissions. The 837-I is the electronic version, used by medical billers in institutions that file claims electronically.

These forms, whether using the paper or electronic version, are more complex than the CMS-1500. This is largely due to the wider range of services provided in the institutional care setting, which means that claims forms must be able to accommodate a larger number of medical codes. Complete UB-04 form instructions can be found in Chapter 25 of the Medicare Claims Processing Manual (PDF) .

Becoming very familiar with these forms – and the differences between them – is essential for success as a medical biller. For that reason, students who are working towards a degree in Medical Reimbursement and Coding will find that managing these forms and other essential elements of claims generation will certainly be an area of focus in their coursework.

For more information about medical billing and coding courses at Bryant and Stratton College, contact the Admissions Office at 1.888.273.2758.

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