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

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.

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.

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.

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