What form is used for submitting non-institutional claims to Medicare/Medicaid for healthcare services?

The CMS 1500 form is specifically designed for submitting non-institutional claims to Medicare and Medicaid for healthcare services. This form is utilized by individual healthcare providers to report services, procedures, and supplies provided to patients in a non-institutional setting, such as a physician’s office or outpatient service.

The CMS 1500 form is vital for ensuring proper reimbursement from Medicare and Medicaid by detailing the services rendered, the diagnosis, and any relevant codes that correspond to those services. Its structure allows for clear communication of the necessary information to facilitate the claim review and payment processes.

In contrast, other options are used for different purposes. The ICD-10-CM codes are used for diagnosis coding but do not themselves constitute a claim form. The CPT (Current Procedural Terminology) codes are also not a claim form; they are a set of medical codes used to report specific medical, surgical, and diagnostic services. The NCQA (National Committee for Quality Assurance) focuses on healthcare quality and does not relate to the submission of claims for services. These distinctions clarify why the CMS 1500 form is the correct choice for non-institutional claims for Medicare and Medicaid.