View Other Articles

Bill Instructions: CMS-1500 (HCFA)

Last update
June 18, 2019

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

Article Contents

Navigation Link

CMS-1500 (HCFA)

Applicable Services

Filling out the Form

Instructions

Required Reports

Forms & Attachments

Timely Filing

120 days from DOS

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.

Service

 Rule

Physician Services

Indiana Administrative Code
Title 631; Article 1. Worker's Compensation 1-1-32 (2)(A)(i)
 

Laboratory / Pathology

DME

Dispensed Pharmaceuticals

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.

CMS-1500 Medical Bill

Recommended Documents

Treatment

Recommend attaching chart notes or Physician’s Report State Form 2118

Surgery

Operative Report

Radiology

Radiology Report if billing for professional component

Laboratory

Test Results Report

Diagnostic Testing

Test Results Report

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.

Form

Timely Filing

Indiana Administrative Code

Rule

Medical Bills

120 days

Title 631 Worker’s Compensation Board of Indiana; Article 1.

Article 1. Worker's Compen, 1-1-32 (2)(A)(i).

Back to Top

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

How did you like the article ?