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The CMS 1500 form is a standardized medical claim form used by individual healthcare providers, such as physicians, therapists, and midwives, to submit billing information for services provided to patients.
When a physician has a private practice but performs services at an institutional facility such as a hospital or outpatient facility, the CMS-1500 form would be used to bill for their services. The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities.
-The CMS-1500 Health Insurance Claim Form is used by most health insurance payers for claims submitted by physicians and suppliers.
Providers billing for professional services, and medical suppliers, must complete the CMS-1500 (version 02/12) form. The form must be completed in ance with the guidelines in the National Uniform Claim Committee (NUCC) 1500 Claim Form Reference Instruction Manual Version 5.0 7/17.
How to file a Washington State Tort Claim Submit online. Submit a tort claim online securely. Submit by fax. Submit the completed Washington State Tort Claim form to the following fax number: 360-507-9251. Submit by mail. Submit in person. Checklist for filing your Washington State Tort Claim form. Frequently Asked Questions.
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The Health Insurance Claim Form (CMS-1500) is used by Allied Health professionals, physicians, laboratories and pharmacies to bill supplies and services to the Medi-Cal program.

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