CMS 1500
The CMS 1500 (formerly HCFA 1500) is the standard paper claim medical form used by non-institutional healthcare providers, such as private practices, to submit a claim for billing Medicare Fee-For-Service (FFS) Contractors for Part B covered services and some Medicaid-covered services. The CMS 1500 is sometimes also suitable for billing various government and some private insurers and is accepted by most health insurance providers. The CMS 1500 has been updated to include National Provider Identifiers (NPIs), or unique numbers required by HIPAA and contains all the basic information needed to submit an accurate claim. Before a claim is submitted, a number of technical protocols and industry standards must be met for insurance claims to be delivered expediently and accurately between medical practice and payer.
Perform all of your claims processing faster, with less errors and less effort in one easy-to-use, affordable application.
The cutting-edge technology of our software
streamlines the processing of healthcare claims to offer
the leading innovative data management solution.
- Once the form is imported (copied or scanned) into our system, recognition begins:
Once the form is scanned, our software uses Optical Character Recognition (OCR) to recognize machine printed data from scanned images, as well as Intelligent Character Recognition (ICR) that can read hand printed data to electronically isolate and record information provided in the different fields, transferring and filling that information. This includes all information on the form, such as:
- Patient information
- Insurance information
- Each line of the services provided
- Account information
- Billing information
- Patient signatures
- Injury related dates
- Diagnosis codes
- Submission data
Streamline operations for the processing of healthcare claims
using our automated processing system
.
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2. Our software checks for errors, then flags and prioritizes those errors.
Our software checks for errors, then flags and prioritizes those errors by low confidence fields for easy verification or correction. Low confidence areas are highlighted for fast review.
3. Edit or verify the recorded information.
You can review and edit all the data automatically recorded from the form.
4. The proper organization and format of the form is automatically generated
using a set of standards to meet the requirements mandated by the HIPAA Transactions and Code Set Rule (TCS) to allow for accurate claim submissions.
5. Export and store your claim.
When verification is complete, all the data is automatically exported to your claims processing system and stored in a database.
Improve your Clean Claim Rate (CCR)!
Implement the medical industry best Denial Prevention mechanisms.
Clean Claim Rate (CCR)
In healthcare revenue cycle management, the Clean Claim Rate (CCR) is a critical metric for assessing billing efficiency and operational effectiveness. This key performance indicator (KPI) serves as a foundational measure of an organization’s ability to submit claims that comply with payer requirements and facilitate timely reimbursement.
Given the increasing pressure on healthcare providers to optimize revenue cycle performance while sustaining high-quality patient care, a strategic focus on improving the Clean Claim Rate has become essential.
The Clean Claim Rate is defined as the percentage of claims that are accepted and reimbursed upon initial submission, without being subject to rejections, denials, or requests for additional documentation. In practice, these “clean” claims progress seamlessly through the billing lifecycle, enabling prompt and predictable payment.
An acceptable clean claim rate is 80%. However, to ensure high quality and accuracy, a benchmark of 90% or higher is ideal. A CCR below 80% results in lost revenue.
A key factor in this equation is the manual “touch rate” (manual data entry) which contributes to the 29% rejection rate seen in current industry data. This makes it nearly impossible to achieve a 90% CCR when claims are entered manually.
Denial Proof your healthcare claims management.
Does your organization enter data from healthcare claim forms?
“For the past year, Community Eye Care has had the pleasure of partnering with ScanStore and ABBYY for our scanned claims functionality. The ABBYY software, combined with ScanStore’s technical expertise, has enabled us to scan 80% of the paper HCFA claims we receive every month. The scanning software has increased our productivity as well as our employee satisfaction and has eliminated the need to bring on additional staff for the foreseeable future.”
HICFA FORMS PROCESSING
Discover how quickly and easily you can scan, index, and sort claims forms. Our predefined templates eliminate the extra headaches of data capture.
