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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 Maine.

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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 Maine rules which require a provider to use the CMS-1500 (HCFA) for billing purposes.

Service

Rule

Physician Services

CHAPTER 5 MEDICAL FEES; REIMBURSEMENT LEVELS; REPORTING REQUIREMENTS 1.06

Laboratory / Pathology

Facility – Outpatient

DME

Dispensed Pharmaceuticals

CMS-1500 Form Instructions

The state of Maine requires providers to compliantly complete the CMS-1500 Form, but provides no further specification.

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, Maine 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.

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 Maine Billing Guide.

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