Bill Instructions: CMS-1500 (HCFA)

For the listed services, the following table reflects the requirements for submitting a complete workers’ comp bill in New Hampshire.

CMS-1500 Form Instructions

The state of New Hampshire has no specific requirements for any billing forms. It is recommended that providers compliantly complete the CMS-1500 Form.

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, For a complete bill, the provider should consider submitting the following supporting documentation with the CMS-1500 Form when applicable.

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

DaisyBill Solution

Stay up-to-date on the latest developments in workers’ compensation medical billing by subscribing to DaisyBill’s email list.

SIGN UP FOR EMAILS