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Delaware Bill Instructions: CMS-1500 (HCFA)

In Delaware, healthcare providers use the CMS-1500 (HCFA) Form to file original workers' compensation medical bills.

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CMS-1500 (HCFA)

Applicable Services

Filling out the Form

Instructions

Reporting Requirements

Forms & Attachments

CMS-1500 (HCFA) Services

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

Service

Rule

Physician Services

4.18.1 General Rules Definitions 

Laboratory / Pathology

Dispensed Pharmaceuticals

DME

CMS-1500 Form Instructions

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

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 Documentation

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

CMS-1500 Medical Bill

Required Documents

Treatment

Charges for medical evaluation, treatment and therapy, including all drugs, supplies, tests and associated chargeable items and events, shall be submitted to the employer or insurance carrier along with a bill or invoice for such charges, accompanied by records or notes, concerning the treatment or services submitted for payment, documenting the employee's condition and the appropriateness of the evaluation, treatment or therapy, with reference to the health care practice guidelines adopted pursuant to § 2322C of this title, or documenting the preauthorization of such evaluation, treatment or therapy.

The initial copy of the supporting notes or records shall be produced without separate or additional charge to the employer, insurance carrier or employee.

Pathology / Laboratory

A written report of the laboratory procedure, and consultation with the authorized treating physician.

Unlisted or Unusual Procedure

A service that is rarely provided, unusual, variable, or new may require a special report in determining medical appropriateness of the service. Pertinent information should include an adequate definition or description of the nature, extent, and need for the procedure; and the time, effort, and equipment necessary to provide the service. Additional items that may be included are:

  • Complexity of symptoms
  • Final diagnosis
  • Pertinent physical findings
  • Diagnostic and therapeutic procedures
  • Concurrent problems
  • Follow-up care

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

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