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cms 1500

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Regina Faridnia

Can we get the cms 1500 added to our forms to collect a signature online (boxes 12 & 13)?  I have had to get this signed in person, since it is not yet in the simple practice system with my other forms.  When we bill we have to say that we have a signature on file.  

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Comments

9 comments

Date Votes
  • Gillian

    Hi Regina, I'd be happy to help with this. Are your insurance payers requesting a physical signature in boxes 12 and 13? Typically, a physical signature is not required here - if the client signs a release of information, their signature is on file with you. There's a template for Release of Information in the SimplePractice Notes and Forms section under My Account > Settings > Notes and Forms > Template Library. Let me know if the claims generated by SimplePractice are being rejected or denied due to the lack of a physical signature from the client. 

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  • Regina Faridnia

    Line 12 & 13 are very specific regarding assigning medical benefits for claim purposes to the clinician.  A basic Release of Info would not suffice.  We need to ensure that we are meeting CMS requirements. 

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  • Stephen Monte

    I have a question about this too.  Does SimplePractice have a form for assignment of insurance benefits to the clinician?

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  • Gillian

    Hi Stephen, not currently, no. 

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  • Deborah McNally

    We need to have a way to get electronic signatures for lines 12 and 13 on the CMS 1500.

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  • Ruth
    • Edited

    Hi Deborah,

    If you're filing claims electronically through SimplePractice, this is not a required field, our clearinghouse takes care of all the signatures on file for boxes 12, 13 and 31. The clearinghouse won't auto-populate signatures if you're downloading the claim, printing it out and submitting it outside of SimplePractice. 
     
    If you're billing OON, and are not accepting assignment, box 13 will not be checked, which indicates to the payer that they should pay the client and not the provider (you). Let me know if there's anything else I can clarify. 
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  • Maria NPI 1356821862

    Hello. I am filling out an application to become a provider with an insurance.  They are asking for a BLANK CMS 1500 FORM. I guess with my information not with any patient information. How can I get one via SP? TIA.

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  • Ruth

    Hi Maria, at this time there's no way to create a claims form, or CMS 1500 form, through SimplePractice without having first created a client, marking them insurance pay and holding appointments with them. I'd recommend downloading this form online, outside of SimplePractice. After searching "CMS 1500 form fillable" in Google, here's what I found: https://www.google.com/search?q=cms+1500+form+fillable&oq=cms+1500+form&aqs=chrome.1.69i57j0l4j69i60l2j69i61.4999j0j7&sourceid=chrome&ie=UTF-8  

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  • Zoe Lemaster

    Re Form 1500

    I cannot find any assistance on 3 items I have problems with on form 1500.  They all have to do with either placement of information or missing information.  Editing every bill one-by-one for these errors is vastly time consuming.

    1) How do I get the X to populate a particular checkbox at the top in field 1?

    2) How do I get the "." in a diagnosis code to populate? (Box 21) All our diagnosis codes are missing the . once they download (they look find on the SP screen)?

    3) The 'cents' on the total bill (in box 28) doesn't populate correctly, it always populates off to the right in dollars column, along with the dollars. How do I fix this?

     

    I appreciate any help.  Thank you

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