Washington CMS 1500 (also known as the Health Insurance Claim Form) is a standard form used by health care providers in the United States to submit claims to health insurance companies. It is designed to collect patient and provider information, as well as details about the services provided and the amounts due. The form is used for both paper and electronic health care claims. Washington CMS 1500 forms come in two varieties: CMS-1500 (02/12) and CMS-1500 (08/05). The 02/12 version is the more recent version of the form and is used for all claims submitted on or after June 30, 2015. The 08/05 version is used for all claims submitted before June 30, 2015.
Washington CMS 1500
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CMS 1500
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If you're completely unable to work, time-loss benefits are based on your average monthly gross income at the time of your injury, including wages, health benefits, bonuses, and tips. You'll receive 60% to 75% of that income, depending on your marital status and number of dependents.
The workers' compensation scheme operates on mutual obligations. The employer and insurer have obligations to pay you a salary and cover the cost of your treatment. In return for accepting that salary, you must attend work and undertake duties that are medically appropriate, as indicated on your certificates.
The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of
How to fill out a CMS-1500 form The type of insurance and the insured's ID number. The patient's full name. The patient's date of birth. The insured's full name, if applicable. The patient's address. The patient's relationship to the insured, if applicable. The insured's address, if applicable. Field reserved for NUCC use.
Online via our FileFast tool. By phone: 1-877-561-FILE (3453) At your doctor's office (if you complete the Report of Accident at your doctor's office, the doctor files the form for you)
The Form CMS-1500 is the standard paper claim form to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed. In addition to billing Medicare, the 837P and Form CMS-1500 may be suitable for billing various government and some private insurers.
File a claim online with FileFast (24-hours per day). Workers can also file by phone at 1-877-561-FILE (3453) Monday ? Friday, 8 a.m. ? 5 p.m.
Workers' compensation insurance (also known as Industrial Insurance) provides wage replacement and medical benefits to workers injured on the job. Workers' compensation is no-fault insurance, which means in most cases your business cannot be sued when a work-related injury or illness occurs.