The CMS-1500 (HCFA) Form is used by healthcare providers and professionals to file original workers' compensation medical bills in Hawaii.
Article Contents |
Navigation Link |
CMS-1500 (HCFA) |
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Filling out the Form |
CMS-1500 (HCFA) Services
The following table provides a link to the Hawaii rules which require a provider to use the CMS-1500 (HCFA) for billing purposes.
Service |
Rule |
Physician Services |
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Laboratory/Pathology |
CMS-1500 Form Instructions
The state of Hawaii requires providers to submit an itemized statement of services. It is recommended that providers complete the CMS-1500 form as detailed in the following tables.
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
For additional information related to reporting please refer to DaisyBill’s Hawaii Billing Guide.
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