The CMS-1500 (HCFA) Form is used by healthcare providers and professionals to file original workers' compensation medical bills in Illinois.
Article Contents |
Navigation Links |
CMS-1500 (HCFA) |
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Filling out the Form |
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Reporting Requirements |
CMS-1500 (HCFA) Services
The following table provides a link to the Illinois regulations which require a provider to use the CMS-1500 (HCFA) for billing purposes.
Service |
Regulation |
Professional Services |
Section 9110.90.8 Illinois Workers' Compensation Commission Medical Fee Schedule
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Evaluation & Management | |
Surgery | |
Radiology | |
Pathology / Laboratory | |
Chiropractic | |
PT / OT |
CMS-1500 Form Instructions
The state of Illinois 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 Suggested Billing Documentation
For a complete bill, Illinois requires the provider to submit the following supporting documentation with the CMS-1500 Form, when applicable.
CMS-1500 Medical Bill |
Recommended Documents |
Treatment |
Section 8.2(d) requires payers to pay bills that contain "substantially all the required data elements necessary to adjudicate the bill." Parties may disagree over what constitutes a complete bill.
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 use refer to DaisyBill’s Illinois Billing Guide.
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