CMS 1500 Claim Form

Shandisa purogiramu 02/12 yekubhadhara kudai navanachiremba uye vatengesi

ICMS 1500 ndiyo yerineni yakatsvuka pamuvara wepepuru wechipatimendi chekutsvaga inoshandiswa navanachiremba uye vatengesi nokuda kwekubhadhara mari. Kunyange zvazvo yakagadzirwa neCenters for Medicare neMedicaid (CMS), yakave iyo fomu yakazara inoshandiswa neinishuwarenzi yevatakuri. Kubva musi waApril 1, 2014, iyo yakadzokororwa version 02/12 ndiyo chete inogamuchirwa neMedare. Iyo yekare nhamba 08/05 haisisiri yakakodzera.

Ndiani Anokwanisa Kubhadhara Zvikwereti Achishandisa CMS 1500?

Chero ani zvake asiri musangano uye mutengesi anogona kushandisa CMS 1500 pamhosva yekurapa yezvokurapa.

Mazano ekugadzirira CMS 1500 Claim Form

Dzimwe mirayiridzo yakazara inogona kuwanikwa pa www.cms.gov kana www.nucc.org

Kuvandudzwa kweCMS 1500 - Version 02/12

Kubudirira musi waJanuary 6, 2014, iyo yakavandudzwa version (02/12) yemafomu eCMS 1500 yakagamuchirwa kuti ishandiswe. Iyo yakadzokororwa CMS 1500 fomu (chinyorwa 02/12) yakagadziridzwa kuti ienderane nemamiriro ekushandura kwekugadzirwa kwemagetsi kubva mundima 4010 kusvika kuhurukuro 5010 ye 837P uye kuchinja kubva ICD 9 kusvika ICD 10 .

Iyo fomu yakatangwa musi waJanuary 6, 2014. Kubva musi waApril 1, 2014, vatapi vanogona kungoshandisa iyo yakarongwa CMS 1500 fomu (version 02/12). Zvose zvakasara mashizha e 08/05 haafaniri kushandiswa.

Kusiyana pakati peChirungu 08/05 uye Version 02/12

  1. Musoro: chikwangwani chemakona chakatsiviwa ne QR code.
  2. Munda Wemunda 1: TRICARE CHAMPUS yakatsiviwa ne TRICARE; SSN yakatsiviwa neI ID #
  3. Munda Wemunda 8: PATIENT STATUS yakatsiviwa neR RESERVED FOR NUCC KUSA
  4. Munda Wemunda 9b: DZIMWE DZIMWE DZAKADZIDZWA MUSORO WOKUTANGA, SEX yakashandurwa neR RESERVED FOR NUCC USE
  5. Munda Wemunda 9c: ZITA RAMUNYORI KANA Chikoro chakatsiviwa neR RESERVED FOR NUCC KUSA
  6. Munda Wemunda 10d: KUTSVIRWA KUNYANZWA KWEZVANHU ZVAKASIMBWA kwakachinjwa neCLAIM CODES (Yakarongwa naNUCC)
  7. Munda Wemunda 11b: ZITA REMUNYORI KANA Chikoro chakatsiviwa neZIMWE DZIDZIDZO YOKUTAURA (Yakarongwa naNUCC); rutsanga rwakatorwa rakawedzerwa kuti rigone kushandiswa kwechipiri chechipiri
  8. Nzvimbo Yomumunda 14: DATE RECURRENT (museve mutsvuku) KUNYA (chiratidzo chekutanga) KUNA INJURY (ngozi) OR PREGNANCY (LMP) yakatsiviwa neDATE OF CURRENT ILLNESS, INJURY, kana PREGNANCY (LMP); CHINHU chakanga chakawedzerwa, uye rwonzi rwakanga rwakawedzerwa kuti rigone kushandiswa kwechidimbu chechidimbu 3
  9. Munda Wemunda 15: KANA PATIATI AKAVA AKANAKA KUNYANYA. Ipa DATE RAKUTANGA rakatsiviwa neAIDS DATE; CHINHU chakanga chakawedzerwa, uye rwonzi rwakanga rwakawedzerwa kuti rigone kushandiswa kwechidimbu chechidimbu 3
  1. Munda Wemunda 17: rutsanga rakatsetseka rwakange rwawedzerwa kuti ruve nekushandisa kushandiswa kwema 2-digit qualifier
  2. Munda Wemunda 19: KUTSVIRWA KUSVANZWA KWENYIKA YAKASVIKWA KWAKASIMBWA kwakachinjwa neZVO ZVINOKUDZIDZWA ZVOKUDZWA (Yakarongwa naNUCC)
  3. Munda Wemunda 21: ICD Ind. Yakawedzerwa uye ruvara rutsva rwakange rwawedzerwa kuti rushandise kushandiswa kwei-digit digit qualifier; 8 mitsara yakawedzerwa yakawedzerwa kuongororwa zviratidzo; mavara ekutsvayamiswa kwemitsetse yekodhi yakashandurwa kubva pane nhamba kusvika kuAlfs
  4. Munda Wemunda 22: MEDICAID RESUBMISSION yakatsiviwa neRUBUBMISSION
  5. Munda Wemunda 30: BALANCE DUE yakatsiviwa neRsvd yeNUCC Kushandisa