The CMS-1500 (HCFA) Form is used by healthcare providers and professionals to file original workers' compensation medical bills in Montana.
Article Contents |
Navigation Link |
CMS-1500 (HCFA) |
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Filling out the Form |
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Required Reports |
CMS-1500 (HCFA) Services
The following table provides a link to the Montana rules which require a provider to use the CMS-1500 (HCFA) for medical billing purposes.
Service |
Rule |
Physician Services |
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Laboratory / Pathology | |
DME |
CMS-1500 Form Instructions
The state of Montana requires providers to compliantly 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
CMS-1500 Required Documentation
For a complete bill, Montana requires the provider to submit the following supporting documentation with the CMS-1500 Form, when applicable.
CMS-1500 Medical Bill |
Required Documents |
Treatment |
To be eligible for payment for subsequent visits, the provider must furnish to the insurer: (a) the treatment bill (CMS 1500); (b) improvement status with respect to the treatment plan; and (c) applicable treatment notes with the bill. |
For additional information related to reporting please refer to DaisyBill’s Montana Billing Guide.
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