Submitting Medical Insurance Claims

tart -->on the state's workers' compensation website.
When it comes to submitting medical insurance claimsIn many states forms can be downloaded and
to the insurance companies, it is important to file theprinted or purchased in quantity by private suppliers.
claims on the appropriate forms. The most commonSome medical billing software comes with the
medical insurance form is the HCFA 1500.capability of printing the workers' compensation
The HCFA 1500 form is a 8 ½"by 11" whiteforms. The workers' compensation forms are white
paper printed with red ink. It contains many fieldswith black print and have fields similar to the HCFA
that must be completed. In an effort to standardize1500 form. As with the HCFA 1500, it is important
the medical industry, HIPAA (Health Insurancethat these fields are filled out accurately and
Portability and Accountability Act of 1996) mandatedcompletely.
that all medical service providers use the HCFA 1500Facilities such as hospitals, outpatient clinics, and
form when submitting insurance claims.ambulatory surgery centers use a UB92 form. It is
It is crucial that the fields on the HCFA form are filledthe facility version of the HCFA 1500. UB92 forms
out accurately and completely. If any information isare also white with red ink, but the fields are
missing or incorrect it can cause the entire claim todifferent.
be denied. In some cases they will return theWhen claims are submitted electronically, no forms
incomplete or inaccurate claim with an explanation asare needed as the claims are not ever printed to
to why it is not being paid. Other times, you justpaper. The claims are actually put into the correct
don't hear anything. Did they end up with your socksformat and sent on to the insurance companies in a
that never returned from the dryer?file. The claims can either be sent via the internet, or
There are some instances that a HCFA wouldn't bethru the phone lines.
used. If the claim is for an on the job injury, or aHCFA and UB92 forms can be purchased from a
workers' compensation claim, then a workers'variety of suppliers and they vary greatly in price.
compensation form would be used. These formsThe higher the quantity purchased, the lower the
vary from state to state, but can usually be foundprice per form.