What is the difference between HCFA-1500 (CMS 1500) and UB-04 (CMS 1450)?

Although these forms look similar, they CANNOT be used interchangeably.

The HCFA 1500 claim form, also known as CMS-1500, enables medical physicians to submit health insurance claims for reimbursement from various government insurance plans including Medicare, Medicaid and Tricare. When a physician has a private practice but performs services at an institutional facility such as a hospital or outpatient facility, the CMS-1500 form would be used to bill for their services.

The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services.

The HCFA-1500 form (CMS-1500) is used to submit charges covered under Medicare Part B. The UB-04 (CMS-1450) to submit charges under Medicare Part A.

New NPI Verification Process through PECOS

There has been an important update from the Centers for Medicare and Medicaid Services (CMS).

CMS has notified ABILITY that as of April 1, 2019 mainframe eligibility applications hosted in Direct Data Entry/Fiscal Intermediary Standard System (DDE/FISS) and Common Working File (CWF) will be undergoing a process change. Users attempting to verify Part A Medicare eligibility benefits will be required to use a National Provider Identifier (NPI) that is registered in the Medicare Provider Enrollment and Chain/Ownership System (PECOS) database. As part of the eligibility process, these eligibility applications will now verify that the NPI used on the inquiry is present in the Medicare PECOS database.

Read more: New NPI Verification Process through PECOS

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