Bill Instructions: CMS (HCFA)

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

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CMS-1500 (HCFA)

Applicable Services

Filling out the Form


Reporting Requirements

Forms & Attachments

Timely Filing

120 from DOS

CMS-1500 (HCFA) Services

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



Physician Services

17.02.04 – Administrative Rules of the Industrial Commission Under the Workers' Compensation Law – Benefits 

Laboratory / Pathology

Facility - Outpatient

CMS-1500 (HCFA) Form Instructions

The state of Idaho 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, Idaho requires the provider to submit the following supporting documentation with the CMS-1500 Form, when applicable.

CMS-1500 Medical Bill

Required Documents


17.02.09–035.C. If requested by the Payor, the bill shall be accompanied by a written report as defined by IDAPA 17.02.04, “Administrative Rules of the Industrial Commission Under the Workers’ Compensation Law -- Benefits.” Subsection 322.01.f. Where a bill is not accompanied by such Report, the periods expressed in Subsections 035.04 and 035.06, below, shall not begin to run until the Payor receives the Report.

For additional information related to reporting please refer to DaisyBill’s Idaho Billing Guide.

Timely Filing

Medical Bills must be filed within 120 days of the date of service for services rendered in Idaho.


Timely Filing

IDAPA Administrative Rule


Medical Bills

120 days


035. Billing and Payment Requirements for Medical Services and Procedures Preliminary to Dispute Resolution. 03

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