The CMS-1500 (HCFA) Form is used by healthcare providers and professionals to file original workers' compensation medical bills in Indiana.

CMS-1500 (HCFA) Services

The following table provides a link to the Indiana rules which require a provider to use the CMS-1500 (HCFA) for billing purposes.

CMS-1500 Form Instructions

The state of Indiana requires providers to compliantly complete the CMS-1500 Form but provides no further specifications.

To make things easier for you, daisyBill created this NUCC CMS-1500 Instructions Table showing the requirements of the National Uniform Claim Committee (NUCC), the entity which created and maintains the form. This information is provided for educational purposes only and is not intended to represent state-specific requirements.

For additional information, review the complete NUCC Manual:
1500 Health Insurance Claim Form Reference Instruction Manual for Form Version 02/12

CMS-1500 Required Billing Documentation

For a complete bill, Indiana requires the provider to submit the following supporting documentation with the CMS-1500 Form, when applicable.

For additional information related to reporting please refer to daisyBill’s Indiana Billing Guide.

Timely Filing

Medical bills must be filed within 120 days of the date of service for all services rendered in Indiana.

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