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CLAIM FORM FOR HEALTH PROFESSIONAL SERVICES

CLAIM FORM FOR HEALTH PROFESSIONAL SERVICES 2025

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The document is a claim form for health professional services provided by Green Shield Canada. It outlines the necessary sections for patient and provider information, mandatory declarations regarding other insurance coverage, treatment details, authorization and consent for personal information use, assignment of benefits, and mailing instructions. The form emphasizes that no staples should be used and that it must be completed fully by the provider to process claims efficiently.

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Versions	Form popularity	Fillable & printable
2022	4.3 Satisfied (37 Votes)
2014	4.6 Satisfied (33 Votes)
2013	4.7 Satisfied (48 Votes)
2011	4.6 Satisfied (52 Votes)
2006	4 Satisfied (33 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are the two types of claims forms?

The two most common claim forms are the CMS-1500 and the UB-04. These two forms look and operate similarly, but they are not interchangeable. The UB-04 is based on the CMS-1500, but is actually a variation on itits also known as the CMS-1450 form.

What is the difference between UB04 and CMS 1500?

The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services. The HCFA-1500 form (CMS-1500) is used to submit charges covered under Medicare Part B.

What is a CMS 1500 claim form used for?

The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of

What are the common errors and inaccuracies that occur when filling out CMS 1500 and UB-04 claim forms?

Lets look at these common mistakes. Service coding is inaccurate or not specific enough. Codes were misused. The claim wasnt filed on time. Patient information isnt accurate or is missing. The ICD-10 code is missing or inaccurate. Service provider information missing.

What claim form is used by professional providers?

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. Providers are required to purchase CMS-1500 claim forms from a vendor.

What is the difference between CMS 1500 and UB-04 claim form?

The CMS-1450 form (aka UB-04 at present) can be used by an institutional provider to bill a Medicare fiscal intermediary (FI) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.

What is a CMS 1450 form used for?

A medical claim is a bill that healthcare providers submit to a patients insurance provider. This bill contains unique medical codes detailing the care administered during a patient visit. The medical codes describe any service that a provider used to render care, including: A diagnosis. A procedure.

CLAIM FORM FOR HEALTH PROFESSIONAL SERVICES 2025

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