Medical claims are form requests submitted by healthcare providers to insurance companies and government programs for reimbursement for services rendered. These claims are a central part of the billing process in any healthcare organization. The differentiation between each form of medical claims process allows each organization to file correctly with insurers.
The specific forms of medical claims
The CMS-1500 claims
An article published in the ASHA Leader states, “To receive reimbursement from Medicare and Medicaid, private practitioners must use the CMS-1500 claim form (dated 8/05) required by the Centers for Medicare and Medicaid Services (CMS).” CMS-1500 is a standardized form used by individual healthcare providers like physicians, outpatient clinics, and specialists, to bill for medical services.
UB-04 claims (CMS-1450)
According to the Healthcare Cost and Utilization Project Methods Series report, “The UB-04 institutional claim is used for billing facility charges, including those related to services that occur in the ED and hospital-based AS settings.”
The UB-04 is sometimes known as the CMS-1450 form, a standardized billing form used by larger organizations like hospitals, nursing facilities, rehabilitation centers, and hospices. The form helps these facilities obtain reimbursement from the same sources as the CMS-1500, including Medicare, Medicaid, or private insurance for more complex and extensive services.
Dental claims (ADA form)
Dentals claims is a billing form specifically used by dentists and dental care providers to claim reimbursement for services provided. The American Dental Association states, “The ADA Dental Claim Form provides a common format for reporting dental services to a patient's dental benefit plan.”
Why medical forms are shared using HIPAA compliant email
Medical claims forms are a wealth of protected health information (PHI). Security during the transmission process is crucial.
Regular email lacks the advanced security features to ensure communications are not hacked or intercepted. By making use of HIPAA compliant email, that boasts encryptions and a host of other security features, healthcare organizations and the recipients of these claims forms can ensure that data remains encrypted and easily accessible.
Related: Understanding medical claims issues in healthcare
FAQs
What is Medicare?
A federal health insurance program for people aged 65 and older and for younger individuals with disabilities.
What is Medicaid?
A joint federal and state program providing health coverage to low income individuals and families.
What is encryption?
A security process that converts information into a coded format making it readable to unauthorized users.
Kirsten Peremore
