Ilungiselela ifomu le-CMS-1500 yeSimangalo Sezokwelapha

Ifomu Lokukhokhiswa Kwehhovisi Lezokwelapha lweMedare, iMedicaid, ne-Insurers

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I-CMS-1500 iyifomu elibomvu le-in-red-in-white-fomu yokufunwa ejwayelekile elisetshenziswe odokotela nabahlinzeki ngezinkokhelo zokumangala. Nakuba lakhiwa yiCenter for Medicare and Medicaid (CMS), seliye ifomu elijwayelekile elisetshenziselwa bonke abathwali bomshuwalense.

Ibukezwa ngezikhathi ezithile. Kusukela ngo-Ephreli 1, 2014, i-version ebuyekeziwe ye-02/12 yiyona kuphela eyamukelwa yi-Medicare.

Inguqulo endala 08/05 ayisasebenzi.

Ubani Ongakwazi Ukufaka Izimangalo Zomthetho Ngokusebenzisa i-CMS-1500?

Noma yikuphi umhlinzeki ongenazikhungo nomhlinzeki angasebenzisa i-CMS-1500 izimangalo zezokwelapha zokukhokha .

• Izinsizakalo zezokwelapha
• Abasizi bezokwelapha
• Abahlengikazi abahlengikazi
• Ochwepheshe bamahlengikazi emitholampilo
• Ababelethisi abahlengikazi
• Abahlengikazi abahlengikazi ababhalisiwe abaqinisekisiwe
• Izazi zengqondo zemithi
• Abasebenzi bezenhlalakahle emitholampilo
• I-home dialysis inikeza kanye nemishini
• Ambulance services
• Izinsizakalo ze-laboratory zokuxilongwa ngemithi

Amathiphu wokulungiselela i-CMS-1500

• Qinisekisa ukuthi yonke idatha ifakiwe ngendlela efanele futhi ngokunembile emasimini afanele.
• Faka ulwazi lomshuwalense kufaka phakathi negama lesiguli ngendlela ebonakala ngayo ekhadini lomshuwalense.
• Sebenzisa amakhodi okuxilongwa okulungile (i-ICD-9) namakhodi wenqubo (CPT / HCPCS) usebenzisa ama-modifiers uma kudingeka.
• Sebenzisa kuphela ikheli lendawo yendawo yendawo yesevisi.
• Ungakhohlwa ukufaka ulwazi lwe-NPI lapho kubonisiwe khona.

Imiyalo eningiliziwe ingatholakala ku-www.cms.gov noma ku-www.nucc.org

Ukubuyekezwa kwe-CMS 1500 - Inguqulo 02/12

Ngempumelelo ngoJanuwari 6, 2014, i-version ebuyekeziwe (02/12) yefomu ye-CMS 1500 ivunyelwe ukusetshenziswa. Ifomu le-CMS le-1500 elibuyekeziwe (i-version 02/12) lakhiwe ukuze lihambisane nezinguquko zesakhiwo ekukhokheni kwe-elektroniki kusuka ku-version 4010 kuya ku-5010 ka-837P kanye nokushintshwa kusuka ku-ICD 9 kuya ku-ICD 10.

Leli fomu laqaliswa ngoJanuwari 6, 2014. Ngomhla ka-Ephreli 1, 2014, abahlinzeki bangasebenzisa kuphela ifomu elibuyekeziwe le-CMS 1500 (version 02/12). Noma yimaphi amasheya asele ka-08/05 akufanele asetshenziswe.

Umehluko Phakathi kwe-version 08/05 no-Version 02/12

1. Inhloko: uphawu lwama-rectangular lushintshwa ngekhodi ye-QR.
2. I-Field Locator 1: I-TRICARE CHAMPUS ithathelwe indawo yi-TRICARE; I-SSN ithathelwe esikhundleni nge-ID #
3. Indawo Yendawo Yendawo 8: ISITATIMENDE SEMPATIENT sashintshwa yi-RESERVED FOR NUCC USE
4. Indawo Yendawo Yendawo 9b: OKUNYE UMTHETHO WOKUPHILWA KWEZOKUPHILA, UKUSEBENZISWA KWE-SEX kwafakwa esikhundleni se-RESERVED FOR NUCC USE
5. Indawo Yendawo Yendawo 9c: IGAMA LOMSEBENZI NOMA ISIKOLO sashintshwa yi-RESERVED FOR NUCC USE
6. Indawo Yendawo Yendawo 10d: UKUSETSHENZISWA KWEZOKUSEBENZISWA KWEZINDAWO ZOKUSEBENZISWA KWEZINDLELA kwashintshwa ngamakhodi e-CLAIM (Okukhethwe yi-NUCC)
7. Indawo Yendawo Yendawo 11b: IGAMA LOMSEBENZI NOMA ISIKOLO sithathwe esikhundleni se-ID YOMTHETHO WOKUKHALWA (Okushiwo yi-NUCC); umugqa onamachashazi wanezelwa ukuze kusetshenziswe isitifiketi samadijithi amabili
8. Indawo ye-Field 14: UMHLA WESIKHATHI (umcibisholo obomvu) ILLNESS (isibonakaliso sokuqala) NOMA INJURY (engozini) OKUTHI UKUQALA (LMP) kwashintshwa ngo-DATE OF CURRENT ILLNESS, INJURY, noma PREGNANCY (LMP); I-QUAL yanezelwa, futhi umugqa onamachashazi wanezelwa ukuze kusetshenziswe isitifiketi samadijithi amathathu
9. Indawo Yensiza 15: UKUBA UMPATENTI AKHENZEKA KANYE NOMA UKUPHILA OKUNYE. NOMA UMHLA WOKUQALA wangena esikhundleni se-OTHER DATE; I-QUAL yanezelwa, futhi umugqa onamachashazi wanezelwa ukuze kusetshenziswe isitifiketi samadijithi amathathu

1. I-Field Locator 17: umugqa onamachashazi wanezelwa ukuze kusetshenziswe isitifiketi samadijithi amabili
2. Indawo Yendawo Yezingu-19: UKUSEBENZISWA KOKUSEBENZISWA KWEZINDAWO ZOKUSEBENZISWA KWEZINDAWO KUNYE KWENYAKA YAMANYE NOKWENZEKA NGOKWENKULWA KWEMALI
3. Indawo ye-Field Locator 21: I-ICD Ind. Yanezelwa futhi umugqa onamachashazi wanezelwa ukuze kusetshenziswe isitifiketi samadijithi angu-1; 8 imigqa eyengeziwe yanezelwa amakhodi okuxilongwa; Amalebula wendlela yokuxilongwa ikhodi yashintshwa kusukela ezinombeni kuya ku-alphas
4. Indawo Yendawo Yezingu-22: Ukubuyiswa kwe-MEDICAID kwafakwa esikhundleni se-RESUBMISSION
5. I-Field Locator 30: I-BALANCE DUE ishintshwe ngu-Rsvd ye-NUCC Sebenzisa