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

CMS-1500 (HCFA) Services

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

CMS-1500 Form Instructions

The state of Tennessee requires providers to compliantly complete the CMS-1500 form as recommended by the NUCC.

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 Supporting Documentation

The Workers’ Compensation Bureau does not require the provider to submit supporting documentation with the CMS-1500 Form but, in case of a dispute with employers, providers should be prepared to furnish the following documentation:

For additional information on reporting please refer to daisyBill’s Tennessee Billing Guide.

Timely Filing

Medical bills must be filed within 12 months of the date of service for all services rendered in Tennessee.

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