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Bill Instructions: CMS-1500 (HCFA)

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

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CMS-1500 (HCFA)

Applicable Services

Filling out the Form

Instructions

Required Reports

Forms & Attachments

Timely Filing

75 days from DOS

CMS-1500 (HCFA) Services

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

Service

Rule

Physician Services

Electronic Billing Rules 101-109

Laboratory/Pathology

Facility - Outpatient

DME

Dispensed Pharmaceuticals

CMS-1500 Form Instructions

The state of North Carolina requires providers to bill electronically. Electronic billing reflects the same components as 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 Suggested Billing Documentation

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

CMS-1500 Medical Bill

Recommended Documents

Treatment

Recommend attaching chart notes.

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 North Carolina Billing Guide.

Timely Filing

Bills must be filed within 30 days of the date of service for all medical services rendered in North Carolina.

Form

Timely Filing

Workers’ Compensation Act

Rule

Medical Bills

A provider of medical compensation shall submit its bill for services within 75 days of the rendition of the service, or if treatment is longer, within 30 days after the end of the month during which multiple treatments were provided.

Ch. 97

11 NCAC 23J . 0101 – Available Reports

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