Which form does a third-party payer require for physician services?

Which form does a third-party payer require for physician services?

• A. CMS-1500
• B. UB-04
• C. EDI 837P
• D. HCFA-1500

Answer: (A)

For physician services, the professional claim form is used. The standard form for billing professional (physician) services to third-party payers is the CMS-1500. It collects patient and provider information, codes for services (CPT/HCPCS), diagnoses (ICD), and charges needed for reimbursement. UB-04 is for institutional claims like hospitals, not for physician services. HCFA-1500 is an older name for the same form, but today the current designation is CMS-1500. If submitting electronically, claims are sent as EDI 837P, which is the electronic version of the CMS-1500.

For physician services, the professional claim form is used. The standard form for billing professional (physician) services to third-party payers is the CMS-1500. It collects patient and provider information, codes for services (CPT/HCPCS), diagnoses (ICD), and charges needed for reimbursement. UB-04 is for institutional claims like hospitals, not for physician services. HCFA-1500 is an older name for the same form, but today the current designation is CMS-1500. If submitting electronically, claims are sent as EDI 837P, which is the electronic version of the CMS-1500.