HIPAA 837 and CMS-1500 Claims Forms

Similarity in Elements Between HIPAA 837 and CMS-1500 Claims

HIPAA 837 and CMS-1500 are both claims forms used for billing insurers for
services provided to patients. While HIPAA 837 claims form is used to electronically
transmit claims, CMS-1500 is claim form that is based on paper (Allwell, 2017). HIPAA 837
claims form is used by healthcare suppliers and professionals to electronically transmit
healthcare claims. CMS-1500, on the other hand, is used for billing Medicare Fee-For-
Service (FFS) contractors in cases where the use of paper claims is allowed. Both forms can
also be used to bill some private and government insurers (Allwell, 2017).

Despite some differences between the two forms, their data elements are identical.
Data elements on the CMS-1500 form claim include name of the patient and their address in
addition to items 1-33 where the biller provides a wide range of data (Allwell, 2017). The
data includes types of services provided to the patient, details of the provider, and
information about the patient’s health insurance. HIPAA 837 form contains the same type of
data. However, it is organized in a slightly different way to make its transmission more
efficient.

How Each Form Relate to Claims Process

Both CMS-1500 and HIPAA 837 relate to claims process by collecting information
regarding diagnosis, procedure, and other information relevant to the processing of claims.

How Similarities Between HIPAA 837 and CMS-1500 Simplify the Claims Process

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I believe that the similarities between CMS-1500 and HIPAA 837 simplify the claims
process. Granted, the two forms do not have the same format. However, they both require the
same information. As they require the same information, a biller only needs to master feeling
one claims form. Once they know how to fill the other form. This simplifies the billing
process because a biller does not need to learn about filling the two forms differently.

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References

Allwell (2017). 2018 Provider and Billing Manual. Superior Healthplan