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6. Claims & Payment

CMS Forms​

Checklist for error-free claim submission

Avoid commonly missed or incorrectly completed claim steps by double-checking the items on this checklist:

  • Member or group number(double-check for accuracy, and include all numeric and alpha characters with no spaces).
  • Individual provider NPI number in field 24J.
  • Procedure codes billed with the correct units of service.
  • Correct combinations of field 24E and field 21 (diagnosis fields on CMS 1500 form).
  • All surgical procedures for the same date of service combined on a single claim.
  • Spelling of the patient's name; submit exactly the way it appears on their UCare ID card, and double-check the date of birth
  • Use the correct bill type (see Adjustment section of this chapter)